Incidental Dysembryoplastic Neuroepithelial Tumor Identified During the Evaluation of Acute Headache and Vomiting in a Pediatric Patient.

Acute headache in pediatric patients often warrants neuroimaging when accompanied by vomiting or concerning clinical features. While most cases are benign or infectious in etiology, incidental structural abnormalities may be discovered. Dysembryoplastic neuroepithelial tumors (DNETs) are rare, benign, WHO grade I glioneuronal tumors, commonly associated with epilepsy and typically located in cortical regions. We present the case of an eight-year-old boy who presented with acute headache and vomiting and was found to have a left frontal lobe cystic lesion with a "soap bubble" appearance on magnetic resonance imaging (MRI), suggestive of DNET. The lesion was incidentally discovered during evaluation for headache in the context of group A streptococcal (GAS) pharyngitis. The patient had no seizure history or focal neurological deficits. Multidisciplinary consensus favored conservative management with serial imaging. This case highlights the importance of careful interpretation of neuroimaging findings in pediatric headache and supports a watchful-waiting strategy in asymptomatic patients with imaging features consistent with DNET.