LAUSR

BACKGROUND Pilocytic astrocytoma (PA) is a benign glial tumour typically presenting in children. It is rare for adults to present with PA and even less likely to manifest with multiple foci of lesions especially in non-optic or hypothalamic locations. CASE DESCRIPTION Our patient was a 37-year old gentleman presenting with varied cranial neuropathies, cerebellar dysfunction and long tract signs with imaging demonstrating three discrete ill-defined contrast-enhancing lesions affecting the cerebellar peduncles, brainstem and cervico-medullary junction. Neuro-navigation guided biopsy confirmed WHO Grade 1 PA that was treated with radiotherapy. CONCLUSIONS To our knowledge, we believe this is the first case with multifocal infra-tentorial PA on presentation in an adult patient in the absence of a prior history of associated risk factors such as neurofibromatosis 1 (NF1) or chemo-radio-therapeutic intervention.