P108 Ways of clinical expression of the cerebral tumours in children – diagnostic traps

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Abstract

Background

the cerebral tumours in children are characterised by a wide range of clinical behaviours, which are not always in the neurological scope.

Material and Method

Case 1: boy of 3 years and 2 months comes to be hospitalised with general influenced state, dysphagia, refusing to eat. The case is interpreted as an acute angina with aphthous stomatitis and dehydration by lack of food nutriments. After hydro-electrolytic re-balancing, phenomena of intracranial hypertension with bradycardia, rigidity and loss of consciousness occur. The performed neurologic exam and the CT scan set the diagnostic of cerebral tumour of posterior fossa.

Material and Method

Case 2: boy, aged 9 years and 3 months, presents himself at the Emergency Ward for functional impotence, walking disorders with sudden debut after the removal of the gypsum splint (the patient presented a sprain of the left knee 14 days prior to the presentation). It is considered to be a paresis of left sciatic nerve and MRI exam is performed on the lumbar backbone which does not highlight changes, the paresis being of central origin. In the same time, a sudden pain occurs with the functional impotence at the level of the left upper limb. The case is interpreted as total left hemiparesis by lesion of the central nervous system without phenomena of intracranial hypertension. CT cranial scan is performed with contrast substance setting the diagnostic of right frontal-parietal cerebral tumour.

Material and Method

Case 3: boy, aged 6 years and 2 months old, presents himself accusing cephalalgia, vomiting, vertigo, balance and sight disorders. After the clinic paediatrics and neurologic exam, there occurs the suspicion of an intracranial expansive process by the presence of the intracranial hypertension syndrome. Cranial CT scan and cerebral MRI are performed, highlighting the diagnostic of cerebral tumour of posterior fossa with hydrocephaly.

Material and Method

Case 4: boy, aged 2 years and 10 months, comes with cephalalgia, slight somnolence. At the clinic examination, a congested pharynx, nasal obstruction, serous rhinorrhoea, dry cough and right occipital adenopathy are observed. The suspicion of otomastoiditis is raised, reason for it is recommended to be performed a cranial CT scan, but the result of the investigation sets the diagnostic of cerebral tumour of posterior fossa with secondary hydrocephaly.

Conclusions

the symptomatology with isolated vomiting but without other digestive or associated with cephalalgia signs must not be regarded as simple and plain symptoms, particularly in young age, as they may direct to the signs of seriously major conditions and discovered on time, they may present a crucial aspect for the therapeutic success.

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