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CHALLENGES IN RADIOLOGICAL DIAGNOSIS: CRANIOPHARYNGIOMA VS ASTROCYTOMA
E Muçaj1, E Durmishi2, S Muçaj3
11Alma Mater Europea, Campus College "Rezonanca", Prishtina, Kosovo.
Insights
This pediatric case study highlights a 6-year-old boy with worsening epilepsy. Imaging revealed an unexpected brain tumor, challenging initial diagnosis and treatment.
Area of Science:
- Neurology
- Pediatric Neurology
- Neuro-oncology
Background:
- Pediatric brain tumors exhibit distinct characteristics and locations compared to adult tumors.
- Supratentorial lesions constitute 30% of pediatric brain tumors, with low-grade astrocytomas being common.
- Epilepsy can be a symptom of underlying neurological conditions, including brain tumors.
Purpose of the Study:
- To present a challenging case of pediatric epilepsy potentially caused by an undiagnosed brain tumor.
- To emphasize the importance of advanced imaging in diagnosing secondary causes of refractory epilepsy in children.
Main Methods:
- Case report of a 6-year-old male with a history of epilepsy since age 3.
- Clinical evaluation including assessment of worsening seizure frequency, headache, vomiting, visual problems, and fatigue.
- Diagnostic imaging including Magnetic Resonance Imaging (MRI) and Computed Tomography (CT) of the head.
Main Results:
- The patient presented with refractory epilepsy and other neurological symptoms despite antiepileptic therapy.
- Previous diagnostic workup had not included head imaging (MRI/CT).
- Imaging studies revealed an unexpected finding, posing diagnostic challenges.
Conclusions:
- Refractory epilepsy in children warrants thorough investigation for secondary causes, including brain tumors.
- Timely neuroimaging is crucial for accurate diagnosis and management of pediatric neurological disorders.
- This case underscores the complexity of diagnosing pediatric brain tumors presenting with atypical symptoms.
Abstract:
Brain tumors in children and adults differ not only in their cellular characteristics but also in where they typically develop in the brain. In children, 30% of pediatric brain tumors are supratentorial lesions. Low-grade astrocytomas, as pilocytic astrocytoma or craniopharyngioma, are the most common tumors. In this study we describe the case of a 6-year-old male patient, diagnosed with epilepsy at the age of 3, presented to the Pediatric Neurology Clinic for routine check-up. During this visit, it was noticed that the patient has recently experienced frequent epileptic attacks regardless of antiepileptic therapy, and other symptoms such as headache, vomiting, visual problems and tiredness. During these several years of treatment, the patient was never referred for MRI or CT scans of the head. The patient was finally referred to a radiologist for further evaluation and imaging studies. MRI of the head in correlation with CT was performed, due to suspicion of a secondary cause for these epileptic seizures. These imaging studies ultimately identified an unexpected outcome and a real challenge in the right diagnosis.
