Rehabilitation of lateral gaze palsy in a patient with ‘Choroid Plexus Papilloma’

Abstract

Choroid Plexus Papilloma (CPP) is infrequent, neuroectodermal originated, intraventricular tumour of central nervous system that develops from lining of choroid plexus lining. Choroid plexus is responsible for production of cerebrospinal fluid. Patient with CPP therefore presents with symptoms of hydrocephalus due to increased intracranial pressure (ICP). In this case report we have presented an 11-year-old female patient who developed CPP mimicking meningioma in third ventricle. She came with complain of headache, vomiting and diplopia. MRI and CT scan results confirmed the diagnosis. She was initially operated on for ventriculoperitoneal shunting to reduce the elevated intracranial pressure after approximately 25 days of onset of symptoms. Her tumour was removed subsequently, 10 to 15 days after the initial surgery, using a supracerebellar infratentorial approach, with an incision running from her occiput to 6 cm downward. Her primary complaints after surgery included loss of lateral eye movement, poor coordination and balance problems. Early evaluation and rehabilitation for the same were initiated. Exercises for lateral gaze palsy comprised of eye movement exercises by utilising radium objects and target-oriented gaze stabilisation exercise using colourful peg board pieces. The regimen also includes upper and lower limb coordination exercises and balance training.The effects of our treatment strategy were observed during post-rehabilitation follow-up, including improvements in gaze, balance and coordination.