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Mental status changes in children with systemic cancer
1Department of Neurology and Pediatrics, Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA.
Pediatric Neurology
|August 6, 2002
Summary
Changes in mental status in pediatric cancer patients are often iatrogenic, primarily due to opioid-induced encephalopathy. Neuroimaging is crucial for unexplained somnolence but less so for hallucinations.
Area of Science:
- Pediatric Neurology
- Neuro-oncology
- Systemic Cancer Management
Background:
- Altered mental status is a common neurologic consultation reason in pediatric cancer patients.
- Existing literature on this specific patient group is limited.
Purpose of the Study:
- To review neurologic consultations for mental status changes in pediatric cancer patients.
- To analyze clinical presentation, etiology, underlying cancer, and neuroradiologic findings.
Main Methods:
- Retrospective review of neurologic consultations for pediatric cancer patients with mental status changes.
- Analysis of clinical data, cancer type, and neuroimaging results.
Main Results:
- Hematologic malignancies were present in over half of the patients.
- Iatrogenic encephalopathy, mainly opioid-related, was the predominant cause.
- Toxic-metabolic deficits were rare; multiple causative factors were common.
- Neuroimaging aided unexplained somnolence but was less effective for hallucinations.
Conclusions:
- Altered mental status is frequent in actively treated pediatric cancer patients, often iatrogenically induced.
- Hallucinations suggest toxic-metabolic dysfunction; neuroimaging may be unrewarding.
- Brain imaging is mandatory for unexplained somnolence, even without focal signs.