Ischemic Stroke masks in children with malignancies.

Congress:

ECR 2020

Poster Number:

C-05883

Type:

Educational Exhibit

Keywords:

Paediatric, CNS, Emergency, Neuroradiology brain, CT, MR, MR-Diffusion/Perfusion, Chemotherapy, Complications, Imaging sequences, Acute, Ischaemia / Infarction, Retrospective, Case-control study, Performed at one institution

Authors:

E. Seliverstova, N. Natrusova, A. Gorbunov, I. Schederkina, O. Tiganova, E. Petriaikina, N. Kiselev, K. Kondratchik; Moscow/RU

DOI:

10.26044/ecr2020/C-05883

DOI-Link:

https://dx.doi.org/10.26044/ecr2020/C-05883

Fig. 1: Stroke. Child, 6 y.old with parameningeal alveolar rhabdomyosarcoma with...

Fig. 2: Methotrexate-related leukoencephalopathy with stroke-like symptoms, resulting...

Fig. 3: Posterior reversible encephalopathy syndrome (PRES) in patient 5 y.o. with ALL...

Fig. 4: Toxic leukoencephalopathy, resulting from administration of the...

Learning objectives

To describe MRI neuroimaging findings of different conditions that might be cause of stroke-like syndromes in children with cancer. To list most common disorders that mimic stroke and are often misdiagnosed as stroke. Describe MRI key imaging findings that differentiate “masks” of ischemic stroke diseases from strokes. To perform a proper differential diagnosis in order to establish an optimal therapy in debut of neurological symptoms.

Background

The “masks” of ischemic stroke are varied in pediatric practice. The main reasons for neurological consultation of children with cancer are seizures, acute focal neurological symptoms, alteration of consciousness. Differential diagnosis of ischemic stroke is particular difficulty due to the risk factors of cerebrovascular disorders in children with malignancies. The underlying disease and therapy, symptoms of neurological complications make it necessary to exclude (or confirm) a stroke at the first diagnostic step.

Findings and procedure details

All 13 patients underwentemergencyMRI investigation in sequences to accept standard brain imaging. EEG were carried out in all cases also. Among these patients neurological symptoms were: hemiparesis -5/13, seizures and alteration of consciousness-7/13, headache-1/13. Hyponatremia and hypocalcemia were not revealed in all 7 cases of seizures. Three patients were diagnosed with ischemic stroke (figure 1), but in the reassessment of MR studies in 2 of them the diagnosis of stroke was changed: in 1 case was stroke-like leukoencephalopathy (figure 2,5), in the other case -...

Conclusion

Differential diagnosis mimics of ischemic stroke is particular difficulty due to the risk factors of cerebrovascular disorders in children with tumors. Special symptoms of debut neurological complications make it necessary to exclude a stroke at the first diagnostic step with MRI “gold standard” brain examination. Adequate patient management play an important role in reducing forced breaks in programmed cancer therapy in children.

Personal information and conflict of interest

E. Е. Е. Seliverstova; Moscow/RU - nothing to disclose N. Natrusova; Moscow/RU - nothing to disclose A. Gorbunov; Moscow/RU - nothing to disclose I. Schederkina; Moscow/RU - nothing to disclose O. Tiganova; Moscow/RU - nothing to disclose E. Petriaikina; Moscow/RU - nothing to disclose N. Kiselev; Moscow/RU - nothing to disclose K. Kondratchik; Moscow/RU - nothing to disclose

References

1.Ahola DT, Provenzale JM, Longee DC. Metastatic rhabdomyosarcoma presenting as intracranial hemorrhage: Imaging findings. Eur J Radiol. 1998;26:241–3. 2.Arush MW, Kollender Y, Issakov J, Shalom RB, Arieh YB, Malkin L, et al. Unusual leptomeningeal dissemination in a child with extracranial metastatic alveolar rhabdomyosarcoma. Pediatr Hematol Oncol. 2009;26:473–8. 3.Bhojwani D. et al. Methotrexate-Induced Neurotoxicity and Leukoencephalopathy in Childhood Acute Lymphoblastic Leukemia. Journal of Clinical Oncology 32(9)· February 2014. doi: 10.1200/JCO.2013.53.0808. 4.Chernyshev OY, Martin-Schild S, Albright KC, et al: Safety of tPA in stroke mimics and neuroimaging-negative...