Pseudomigraine with prolonged aphasia in a child with cranial irradiation for medulloblastoma
S N Krishna Murthy1, Michael E Cohen
1Department of Neurology, SUNY/Buffalo, Children's Hospital of Buffalo, New York 14222, USA. mecohen@acsu.buffalo.edu
Insights
A child treated for medulloblastoma developed migraine-like symptoms and neurological deficits mimicking stroke. These symptoms were likely caused by cerebral vasospasm, a potential long-term complication of cancer treatment.
Area of Science:
- Pediatric Neurology
- Neuro-oncology
- Vascular Neurology
Background:
- Medulloblastoma treatment, including surgery and radiation, can lead to long-term complications in children.
- Cerebral vasospasm is a known complication following certain medical interventions and can cause ischemic events.
Observation:
- A 12-year-old patient, post-medulloblastoma treatment, presented with recurrent migraine-like headaches and transient neurological deficits (aphasia, hemiparesis).
- Initial investigations, including neuroimaging, revealed no structural lesions, despite progressive neurological deterioration.
- The patient experienced a complete neurological recovery over six weeks.
Findings:
- The clinical presentation and recovery pattern strongly suggested cerebral ischemia secondary to vasospasm.
- The patient's symptoms mimicked migraine headaches, highlighting a diagnostic challenge.
Implications:
- This case suggests cerebral vasospasm may be an underrecognized long-term complication of central nervous system neoplasia treatment in children.
- Increased awareness is needed for clinicians managing pediatric cancer survivors to recognize and manage these potentially devastating neurological events.
- Further research into the mechanisms and preventative strategies for treatment-related vasospasm in pediatric oncology is warranted.
Abstract:
We report a 12-year-old child with episodes of migraine-like headaches with visual and motor auras a year after the surgical resection and radiation therapy for medulloblastoma The patient presented with an episode of headache, prolonged aphasia, right hemiparesis, status epilepticus, and salt wasting. There was no evidence of a structural lesion. The neurologic deficits resolved over a period of 6 weeks. Because of the progressive deterioration in neurologic deficits, the patient underwent an extensive battery of laboratory tests and multiple neuroimages, all of which were normal. The unusually prolonged neurologic deficit in this patient without demonstrable structural lesions and his eventual complete recovery were most likely caused by ischemia in the left hemisphere secondary to vasospasm. This presentation mimics migraine headache. Evidence suggesting that this represents a long-term complication of treatment of children with central nervous system neoplasia is presented.
