Migrainous headache and gliotic thalamic lesion after treated neuroblastoma in childhood

Abstract

Objective. This article aims to bring into attention the challenges of diagnosing a case of migraine in a child with a history of neuroblastoma and an associated finding of gliotic thalamic lesion on the cerebral MRI. Materials and methods. The patient underwent a thorough neurological examination, followed by paraclinical tests: blood workup, cerebral MRI with TOF (time-of-flight) angiography, electroencephalogram (EEG), carotid and vertebral arterial Doppler examination, trancranial Doppler examination, cardiac and abdominal ultrasounds, psychological evaluation. Results. The neurological examination was normal, except for right sided post-surgical Claude Bernard-Horner’s syndrome. His blood workup, ultrasounds, EEG, as well as vascular and transcranial Doppler examinations were within normal limits. His cerebral MRI showed a right anterior thalamic ischemic gliotic lesion. Discussions. Neuroblastoma is a common tumor in childhood and its treatment involves surgery, chemotherapy and radiotherapy. A patient with a history of neuroblastoma who has new onset headache has to be evaluated for a possible connection to his pathological background and to the treatment associated with it. A new malignancy and long-term side effects of radiotherapy or chemotherapy must be taken into consideration. Conclusions. The headache episodes were considered as migraine without aura. The article aims to bring into attention the difficulties of diagnosing migraine in children, especially in patients with a neurological history.

Keywords

• neuroblastoma
• child
• headache
• migraine
• thalamic lesion