The Outcomes of an Intensive Outpatient Physical Therapy Plan of Care on a Patient with a 4th Ventricle Tumor after Craniotomy: A Retrospective Case Report

Background and Purpose: Dizziness and vertigo account for roughly 4% of chief symptoms in the emergency department. Ependymomas are rare brain tumors, consisting of 1-5% of central nervous system tumors, that arise from the ependymal lining of the ventricular system of the spinal canal. Signs and symptoms tend to consist of headaches, vomiting, papilloedema, ataxia, dizziness, and nausea. Vestibular physical therapy can be a valuable asset for these individuals to increase functional independence. Case Description: The patient was a 64-year-old Caucasian male who presented to the physical therapy initial evaluation status post craniotomy with symptoms of dizziness, vision issues, decreased endurance, and balance deficits. The patient’s MRI revealed a 4th ventricle tumor, which was removed via uncomplicated resection, approximately 2 weeks before the initial evaluation. In surgery, the tumor could only be partially resected, leading to a radiology consult for complete abolishment of the tumor. Partial resection is a common result of intracranial ependymoma resection surgeries, especially in the 4th ventricle where a complete resection is often not possible. One study found that only 4 out of 33 patients had complete ependymomal tumor resection. Upon resection, the tumor was sent to the lab where it was determined to be an ependymoma World Health Organization (WHO) grade II. The patient’s chief complaints included vertigo, vision problems (diplopia), balance deficits, and self-reported decreased endurance