Psychiatric presentation of a secondary high-grade glioma in a teenager with high-risk pre-B-cell acute lymphoid leukaemia in remission

Sun, Scott; Malicki, Denise; Levy, Michael L.; Crawford, John R.

doi:10.1136/bcr-2021-246249

Cited by 1 publication

(2 citation statements)

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“…Eleven of 18 patients with delayed diagnosis had hemispheric tumors and one third of patients presented with seizures. The most common reason for delay was awaiting an outpatient magnetic resonance imaging (n = 6) that was mostly associated with low-grade gliomas; however, 1 patient was subsequently diagnosed with a diffuse midline glioma following a 3-month history of vertigo, whereas a second patient was diagnosed with a high-grade glioma following an acute psychiatric presentation as has been previously published 15 . Among the 5 patients with nonprimary CNS brain tumors, each was associated with delayed diagnosis; 3 were associated with neuromuscular complaints.…”

Section: Resultsmentioning

confidence: 97%

“…The most common reason for delay was awaiting an outpatient magnetic resonance imaging (n = 6) that was mostly associated with low-grade gliomas; however, 1 patient was subsequently diagnosed with a diffuse midline glioma following a 3-month history of vertigo, whereas a second patient was diagnosed with a high-grade glioma following an acute psychiatric presentation as has been previously published. 15 Among the 5 patients with nonprimary CNS brain tumors, each was associated with delayed diagnosis; 3 were associated with neuromuscular complaints. One third of patients in the delayed diagnosis cohort had a normal or nonfocal neurologic examination, five of which were associated with a presentation of seizure and were subsequently diagnosed with low-grade tumors.…”

Section: Resultsmentioning

confidence: 99%

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Clinical Characteristics and Delayed Diagnosis of Pediatric Patients Presenting to the Emergency Department With a Newly Diagnosed Central Nervous System Tumor

Tamas,

Hollenbach,

Saleh

et al. 2024

Pediatr Emer Care

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Background Due to the varied symptomatology and inconsistent features on neurologic exam, central nervous system (CNS) tumors are difficult to diagnosis in a timely manner. Objective To determine the clinical, neurological, and neuroimaging features of newly diagnosed CNS tumors presenting to the emergency department (ED). Methods We evaluated a retrospective cohort of 121 consecutive patients presenting to a tertiary care pediatric ED over 7 consecutive years with newly diagnosed CNS tumors. Clinical symptomatology, neurologic findings reported by emergency room and neurology physicians, neuroimaging features, and time to diagnosis were analyzed. Results A total of 116 (48 female, median age 8.0 years (interquartile range, 4.4–12.6), 52% Hispanic) presented to the ED (64% self-referred) diagnosed with a brain tumor (54% posterior fossa, 24% embryonal, 24% low-grade glioma, 16% high-grade glioma) resulting in hospital admission in 92% of cases. Five were diagnosed with extradural spinal, clivus, or orbital apex tumors. Symptomatology or duration did not differ when stratified by demographics, location, or histologic subtype. Moderate degree of concordance was observed among neurologic examinations performed by ED physicians and neurologists. Delayed diagnosis (median delay = 3.5 [1–7] months) was seen in 14% of patients, 13 with primary brain tumors (11 hemispheric, 2 brain stem). Six children with delayed diagnosis of low-grade glial tumors had a nonfocal neurologic examination in comparison to 5 patients with abnormal examinations observed with primary spinal or extradural CNS tumors. Four patients with posterior fossa tumors (3 medulloblastoma, 1 ependymoma) had normal/near normal neurologic examination at presentation despite posterior fossa symptomatology related to increased intracranial pressure. Conclusions Our series highlights the complexity of symptomology and neurologic findings in children presenting to the ED with newly diagnosed CNS tumors who may have a normal neurologic examination. Standardization of symptom assessment and focused neurologic examinations may lead to earlier neuroimaging and prevent delayed diagnosis.

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Section: Resultsmentioning

confidence: 97%

Section: Resultsmentioning

confidence: 99%