The spectrum of neurologic disease in children with systemic cancer

To determine the range of neurologic complications in children with systemic cancer, we evaluated prospectively all of the neurologic consultations requested by the pediatric department of Memorial Sloan-Kettering Cancer Center from October 1997 until January 2001. Demographic data, main complaints, diagnosis, cancer status, etiology, and neuroradiologic studies were reviewed for the 528 consultations. Headache was the most frequent complaint (18.3%), followed by altered mental status (8.4%) and back pain (7.1%). Many children with these complaints had underlying structural disorders despite a normal neurologic examination. The symptoms varied with the underlying cancer and tumor status. Headaches were more common in patients with hematologic cancers, and back pain was more common in patients with solid tumors. Chronic headaches were frequent in patients in remission. Iatrogenic complications, particularly related to chemotherapy, constituted the largest etiologic group (27.7%). A high percentage of neuroradiologic studies were abnormal, and 63% of the magnetic resonance imagine studies were diagnostic. The broad spectrum of conditions underlying the neurologic complaints of children with systemic cancer illustrates the complexity of problems presented by these patients and requires a thorough knowledge of pediatric cancer, its effects on the nervous system, and the complications of its treatment from the neurology consultant.