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an ipsilateral hypotonia, resulting in falling to the affected side Herniation of the cerebellar tonsil can cause head tilt toward the tumor and neck pain or stiffness Supratentorial masses may present with signs and symptoms derived from the involved anatomic locations Tumors near the optic chiasm may present with vision deficits Craniopharyngiomas, located in the pituitary gland, can cause visual disturbances, headache, and alterations in endocrine function Growth hormone deficiency or hypothyroidism may cause delayed growth Pineal tumors may cause hydrocephalus by obstructing the aquaduct of Sylvius or can cause Parinaud syndrome (deficits in upward gaze, convergence nystagmus, and impaired pupillary response) Hypothalamic tumors may cause diencephalic syndrome, which includes failure to thrive, wasting, and unusual euphoria If a tumor is located near the third ventricle, hydrocephalus and symptoms of increased ICP can result Masses within the cerebral hemispheres themselves usually present with focal motor dysfunction or seizure The spinal cord may be the site of a primary tumor or, in some cases, the site of a “dropped metastasis” from a primary lesion within the brain These can present with focal neurologic deficits attributable to areas of the spinal cord inferior to the lesion (see “Tumors in and Around the Spinal Cord” section)