Case Reports

Detecting brain tumor using neuroimaging in a patient with severe motor intellectual disabilities

Wakako Ishii, Yuki Imai, Ayumi Endo, Chikako Arakawa, Ryutaro Kohira
Yukihiko Fujita, Tatsuo Fuchigami, Hideo Mugisima, Mariko Kodama¹⁾
Department of Pediatrics and Child Health, Nihon University School of Medicine
Department of Pediatrics, National Rehabilitation Center for Children with Disabilities¹⁾

Abstract

　　We report a case of severe motor intellectual disability（SMID）with a brain tumor. A 8-year-old girl had been bedridden from the age of seven months due to sequela of acute epidural hematoma and cerebral contusion caused by physical abuse. Vomiting and anorexia started six months before admission. As both vomiting and anorexia were habitual in this patient, there was no examination of the causes. Since symptoms gradually intensified during the 6-month period, a brain CT（computed tomography）/ MRI（magnetic resonance imaging）scan was conducted to rule out the possibility of recurring child abuse. The scan revealed ventricular dilatation and a large space occupied by a lesion with calcification around the fourth ventricular lesion.
Detecting malignant disorders in patients with SMID is difficult, because the patients are unable to communicate with physicians, and they present with atypical symptoms. Vomiting, in particular, is one symptom present daily in patients with SMID.
In this case, a CT scan and MRI revealed a brain tumor which reconfirmed the effectiveness of neuroimaging in the diagnosis of typical symptoms in children with SMID. Proper examinations, such as immediate neurological imaging, are recommended for the full recognition of typical symptoms in handicapped children.

Keywords：Severe motor intellectual disability (SMID), Chronic vomiting, Child abuse, Brain tumor, Medulloblastoma