Diagnostic delay in central nervous system tumor: case report of a midbrain pilocytic astrocytoma in preschool child

Abstract

Objective: Report case of a late diagnosed central nervous system tumor due to poor
symptomatology.
Case Description: Male patient, 5 years old, admitted with reflux complaints, difficulty in
gaining weight and episodes of vomiting and diarrhea. Had irregular medical care at the hospital, being the last visit 15 months before. Hospitalized with a diagnosis of gastroesophageal reflux disease, severe malnutrition and diarrhea, weighted 9300g, had a height of 93,5cm and at the neurological examination, it was noted left convergent strabismus. Cranial computed tomography revealed cystic solid mass of posterior fossa, occupying part of the 4th ventricle floor, exerting mass effect on the brain stem. After 19 days of hospitalization, the patient was transferred to referral center for neurosurgery, where subtotal tumor resection was performed. Histological examination revealed pilocytic astrocytoma. In the postoperative period, presented good clinical evolution, improved strabismus, and was referred to adjuvant radiotherapy.
Comments: Pilocytic astrocytoma is considered a Grade I tumor. It is the most common
tumor between the ages of 2-5 years, but its location in the brain stem is very rare. On average, patients are seen by two doctors of different specialties and the mean time to diagnosis for grade I and II tumors is 238 days. Since the symptoms are often nonspecific and are present in other common pediatric diseases, the diagnostic challenge can be significant. A thorough physical examination, especially neurological and ophthalmological, decreases the chance of error and delay in treatment.