Expert Opinion :
This child has raised intracranial tension (vomiting and headache with right lateral rectus palsy), cerebellar signs and lower motor neuron facial palsy (suggestive of lesion in the brain stem – pons). Also presence of brisk reflexes and extensor planters suggest invovlement of the pyramidal tracts which is most likely due to hydrocephalus. The symptoms have been going on for 2 months suggestive of a slow growing lesion such as space occupying lesion. Thus one may consider tumors such as pontine glioma, ependymoma and medulloblastoma. Pontine gliomas usually lead to double vision, weakness, unsteady gait, difficulty in swallowing, dysarthria along with the above symptoms. Medulloblastoma lead to raised ICT due to hydrocephalus, headache and cerebellar symptoms. Ependymoma presents with vomiting, headache, cerebellar signs and diminished social interaction. Thus in this child most likely diagnosis is medulloblastoma with hydrocephalus. MRI confirmed the diagnosis of medulloblastoma with hydrocephalus.