Incidental Subependymoma of the Floor of the Fourth Ventricle: A Case Report

Subependymomas are rare, slow-growing intraventricular tumors that are typically discovered incidentally and seldom present with transient sensory symptoms in young adults. We report the case of a 22-year-old woman who presented with episodic migratory paresthesias and was found on brain MRI to have a small fourth-ventricular lesion radiographically consistent with subependymoma. The patient's sensory symptoms resolved spontaneously, and no further episodes occurred. Conservative management with serial imaging was pursued. At the six-month follow-up, the lesion remained stable, and the patient was asymptomatic. Subependymomas most commonly become symptomatic due to cerebrospinal fluid obstruction, whereas episodic migratory paresthesias are unusual. This case highlights the value of early MRI in young adults with atypical sensory symptoms, which may reveal incidental yet clinically significant findings and help avoid unnecessary invasive testing. Small, non-obstructive fourth-ventricle subependymomas can be safely managed with observation, demonstrating excellent short-term clinical and radiographic outcomes.