Neurological complications in children with non-neurological
malignancies: A single institution experience
Abstract
Purpose: Central nervous system (CNS) involvement usually confers poor
prognosis in cancer. We aimed to estimate prevalence of
neurological-complications (NC) in children presenting with
non-neurological malignancy and to describe type, aetiology and outcome
of such complications Methods: A bidirectional cohort study of children
(1 month-15 years) with non-neurological malignancy was conducted at
tertiary-care teaching hospital, North India. Prevalence and spectrum of
NC was determined. Etiological diagnosis was made using neuroimaging,
cerebrospinal-fluid analysis, nerve-conduction velocity, history and
clinical examination. Results: A total of 1572 patients (870 with
haematological-malignancy; 55.6% and 702 with solid tumours; 44.4%)
were enrolled. Most of them presented within 5-10 years of age and were
males (72%). Overall frequency of NC was 10.5% (Haematological: 9.4%;
solid: 11.8%). Highest proportion of NC was seen in RB (17.2%),
followed by Neuroblastoma (16.6%), acute myeloid-leukaemia (AML)
(16.6%), Ewing’s sarcoma (16.1%) and Langerhans cell histiocytosis
(LCH) (14.2%). Frequent symptoms were seizures (30.9%), headache
(18.2%), bilateral lower-limb weakness (13.3%), altered sensorium
(9.7%), cranial nerve palsy (9.1%), loss of vision (3.0%), pain in
lower-limbs (1.2%), aphasia (0.6%), ataxia (0.6%) and bilateral
hearing loss (0.6%). Common aetiologies of NC included CNS metastasis
or intracranial extension (in RB, Rhabdomyosarcoma), spinal metastasis
(in Neuroblastoma, Ewing’s-sarcoma, germ cell tumour), intracranial
bleed (in AML, Hodgkin’s-lymphoma, ALL), CNS relapse (ALL), CNS
leukaemia (in Non-Hodgkin’s-lymphoma), cerebral atrophy (Wilm’s-tumor)
and Meningo-encephalitis (in LCH). Mortality was high in affected
children (80%). Conclusions: Cancer-specific information about NC may
be beneficial for early recognition and judicious management in order to
prevent neurological or cognitive morbidity.