8‐Year‐Old Boy with Progressive Headache

An 8-year-old boy with no significant past medical history presented to the emergency department following 2 weeks of progressive headaches, fatigue, and vomiting. On physical examination, the patient had no fever, or focal motor or sensory neurological deficits. Initially diagnosed with an H1N1 viral upper respiratory and gastrointestinal infection, he was discharged home with conservative management. After failure to improve over the next several days, a superimposed bacterial infection was suspected. He was given a course of oral antibiotics, which failed to improve his symptoms. Imaging revealed a large, heterogenously enhancing mass measuring 5.6 × 4.7 × 5.2 cm, which contained partially hemorrhagic material centered within the left thalamus extending into the body of the lateral ventricle (Figures 1a). Gross total resection of the tumor was confirmed by postoperative imaging. Staging revealed no metastases. The patient was discharged home 1 week later. NEUROPATHOLOGICAL FINDINGS