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Importance of neuroimaging in children with presumed “cerebral palsy”: a brain tumour series
  1. L Killian1,
  2. K Pohl2,3,
  3. C Woodthorpe3,
  4. D Hargrave4,
  5. T Hedderly3,
  6. C Chandler5
  1. 1Community Paediatrics, South Downs NHS Trust, Brighton, UK
  2. 2Paediatric Neurology, Guys and St Thomas' NHS Foundation Trust, London, UK
  3. 3Paediatric Neurology, Kings Health Partners, Kings College Hospital NHS Trust, London, UK
  4. 4Paediatric Oncology, Royal Marsden NHS Foundation Trust, London, UK
  5. 5Paediatric Neurosurgery, Kings Health Partners, Kings College Hospital NHS Trust, London, UK

Abstract

Aims Cerebral palsy (CP) is the term used to describe motor disorders resulting from a non-progressive insult to the developing brain. Presenting features may include disordered motor milestones or abnormal posture. Recommended pathways of investigation are based on a consensus of expert opinion.1 All children in this case series presented with a motor disorder presumed to fall within the spectrum of CP but later confirmed to have a diagnosis of brain tumour. The authors therefore aim to support recent recommendations from the American Academy of Neurology (AAN) promoting the need for neuroimaging in all children with a descriptive label of CP.

Methods Medical case notes were reviewed retrospectively from a series of children diagnosed with brain tumours who presented initially to community services with disorder in their motor development. The authors will present details of these nine cases (details in table 1), including one child with extreme prematurity. Time from onset of symptoms to diagnosis of tumour varied from 4 months to 3 years 2 months. These children did not undergo further investigation at the time of initial presentation and they were presumed to have CP.

Abstract G10 Table 1

Discussion Brain tumours are the most common solid tumour in childhood and a significant cause of mortality and morbidity. Over 50% of children do not present with signs of raised intracranial pressure.2 Symptoms and signs at presentation are variable and non-specific, including motor disorders or an abnormal motor developmental profile. A recent study reports MRI abnormalities in 84% of children with CP,3 but findings are often non-specific and may not establish aetiology.4 The AAN recommends neuroimaging using MRI in all cases of suspected CP with unknown aetiology.

Conclusion This case series highlights the danger of applying an assumed explanation with the term CP, highlighting the importance of a detailed history and thorough examination during assessment. Prompt neuroimaging should be considered in all children with unexplained neurological symptoms or signs. Early diagnosis of malignancy is now a defined UK strategy. As in other malignancies, prompt recognition of brain tumours may help in the prevention of their significant associated morbidity.

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