Introduction: Medulloblastomas account for approximately 20% of pediatric brain tumors but are rare in adults. We present a case of adult medulloblastoma with radiological features suggestive of cerebellar metastases, along with a literature review focusing on immunohistochemical classification and management strategies. Case Report: A 37-year-old male patient, with a medical history of benzodiazepine use (discontinued six months prior), tobacco and cannabis consumption, was admitted following generalized seizures in a context of increased intracranial pressure and a static cerebellar syndrome. A brain CT scan revealed two cerebellar hemispheric lesions (right and left), associated with perilesional edema and mass effect on the fourth ventricle, resulting in upstream hydrocephalus. Further imaging with MRI demonstrated hypointense lesions on T1-weighted sequences, hyperintense on T2, with no contrast enhancement after gadolinium injection. The patient underwent urgent ventriculoperitoneal shunt (VPS) placement. After stabilization, a stereotactic biopsy was performed and histopathological analysis confirmed the diagnosis of a WHO grade IV medulloblastoma. Discussion: Recent advances in the molecular characterization of medulloblastomas have highlighted significant heterogeneity among subtypes, supporting their classification as distinct pathological entities with unique biological and clinical profiles. Immunohistochemistry plays a pivotal role in both therapeutic decision-making and prognosis, allowing assessment of metastatic and recurrence potential. Furthermore, the extent of residual tumor following surgical resection remains a critical determinant of recurrence and guides the indication for adjuvant radiotherapy. Conclusion: Medulloblastomas can present diagnostic challenges on neuroimaging, particularly on non-contrast-enhanced CT. Our literature review underscores the critical importance of immunohistochemical classification in the therapeutic management of medulloblastomas.