Symptoms of Ependymoma

Ependymoma is a type of brain tumor arising from ependymal cells that line the cavities within the brain (ventricles) and the central canal of the spinal cord. These tumors appear in the brain or spine and can cause a variety of symptoms depending on their location and size. Read on to learn more about ependymomas and their symptoms.

An ependymoma is a type of glioma that begins in the support cells (glial cells) of the central nervous system. Although the exact cause is unknown, ependymomas are thought to arise from ependymal cells that line the cavities of the brain (ventricles) and the central canal of the spinal cord. These cells help to produce a clear and watery substance called cerebrospinal fluid that surrounds the brain and spinal cord.

Ependymomas can affect both children and adults. In children, ependymomas are typically found in the brain. In adults, ependymomas usually develop in the spinal cord. If ependymomas grow large, they can obstruct the passage of cerebrospinal fluid and cause a buildup of pressure. This can lead to symptoms that depend on the location of the tumor.

The symptoms of ependymomas vary depending on the tumor's location, age at diagnosis, and type. In general, larger tumors typically cause more symptoms. Below are possible symptoms based on these factors. 

Supratentorial ependymomas are found in the upper part of the brain and can occur in its cavities (intraventricular) or brain tissue (intraparenchymal). Ependymomas that occur in the ventricles can obstruct the passage of cerebrospinal fluid and cause pressure buildup within the skull. This can lead to symptoms such as headache, nausea, and vomiting. In contrast, ependymomas that occur in the brain tissue can cause a variety of neurological deficits, including:

• Seizures
• Behavioral changes
• Confusion
• Vision problems
• Trouble speaking
• Weakness
• Numbness or tingling
• Difficulty concentrating

Posterior fossa ependymomas occur in the lower part of the brain near the base of the skull and back part of the head. These tumors tend to arise within the ventricle in this area. If sufficiently large, the tumor can obstruct the passage of cerebrospinal fluid and can press on nearby nerves and the cerebellum causing symptoms such as:

• Headache
• Nausea and vomiting
• Lethargy
• Unsteady gait or difficulty walking
• Rapidly growing head circumference in babies

Spinal ependymomas typically occur within the neck or lower back area. Symptoms can be vague and mimic many other conditions. Possible symptoms of spinal ependymoma include:

• Neck or back pain
• Weakness of the arms or legs
• Numbness or tingling in the arms or legs
• Changes in bowel patterns or incontinence

While adults can articulate exactly what they feel is happening to their bodies, children may have a harder time expressing themselves. Young children lack the vocabulary and experience to know how they should describe what they feel. In general, children with an ependymoma in the brain may be observed with the following:

• Persistent vomiting
• Seizures
• Clumsiness, weakness, or vision problems manifesting as bumping into objects or sudden changes in the way they walk
• Lethargy
• Rapidly growing head circumference in babies

Ependymomas can be classified into different types and may be associated with different growth rates. In very slow-growing tumors, you may not experience any symptom at all. In fact, many cases of the Grade 1 subependymoma are found incidentally while imaging the head for an unrelated reason. For tumors that are benign and slow-growing, regular monitoring may be recommended over more invasive treatment options such as surgery.

Tumors that are rapidly growing, such as the historically termed Grade 3 “anaplastic ependymoma” may cause symptoms much sooner than lower grade types. Because anaplastic ependymomas more commonly occur in the brain, symptoms such as headache, nausea and vomiting, and behavioral changes may be experienced.

Many ependymoma symptoms are non-specific, meaning that the symptoms described above are also commonly found in a wide variety of other conditions. Thus, an ependymoma diagnosis is made with a combination of imaging tests such as an MRI and a tissue biopsy.

If you are experiencing any new symptoms, do not hesitate to seek medical attention right away. It will be helpful to take note of when symptoms began, any apparent trigger for your symptoms, and whether your symptoms have worsened in severity. Annual health visits with your primary physician can help to facilitate discussions about any other concerns.

• Ependymomas can occur in the brain or spine.
• Symptoms vary based on location, age, and type of ependymoma.
• Common symptoms of brain ependymomas include headache, vomiting, and behavioral changes.
• Common symptoms of spine ependymomas include neck or back pain, weakness, sensory abnormalities, and bowel changes.

• Collaborative Ependymoma Research Network (CERN)
• American Brain Tumor Association (ABTA)
• The Childhood Brain Tumor Foundation
• Pediatric Brain Tumor Foundation