We present the case of a 5 year old boy who presented to us with complaints of worsening headaches, vomiting, drowsiness and weight loss. He also had difficulty maintaining balance and fell down frequently. Examination revealed elevated blood pressure, sluggish pupils and bilateral grade 1 papilledema. Imaging of the brain showed a mass in the fourth ventricle causing non-communicating hydrocephalus. The mass was excised and histopathology showed features of anaplastic ependymoma. Subsequently

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... he child underwent radiotherapy and post-operative and post-radiotherapy imaging showed no residual disease or metastasis. 10 months later the child complained of recurrent frontal headaches and a lump being felt at the initial surgical scar. Imaging showed a subcutaneous soft tissue lesion in the suboccipital region and a midline lesion between both frontal lobes, suggestive of a metastatic deposit. The child underwent surgical resection of these lesions, which had a similar morphology to the original tumor on histopathology. This case highlights extracranial metastasis in a patient with anaplastic ependymoma. Although recurrence and intracranial spread are well documented outcomes, extracranial metastasis is a very rare and unusual event with such tumors. According to literature, multiple surgeries with radiotherapy can result in a good clinical outcome, even in the presence of extracranial metastasis.