An 8 year old boy presents with slow onset, gradually progressive headaches and lethargy. This is accompanied by vision changes, nausea, vomiting, and most recently, impaired ambulation. His exam shows papilledema, ataxia, and loss of upward gaze. In fact, he has a downward gaze preference. Convergence and divergence are impaired, and bilateral ptosis is noted.
Imaging shows the following:
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