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Journal of Pediatric Neurology
DOI: 10.1055/s-0043-1778647
Case Report

Toe Walking in a Formerly Preterm Child: Is it Just Cerebral Palsy?

Nankee K. Kumar 
1   Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, United States
,
Ashley M. Bach
2   Division of Neurology, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, United States
,
Deborah M. Zarnow
3   Division of Radiology, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, United States
,
Kavita Desai
4   Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
,
Benjamin C. Kennedy
5   Division of Neurosurgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
,
Sonika Agarwal
2   Division of Neurology, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, United States
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Abstract

Spastic diplegic cerebral palsy (CP) is common among children born preterm and is a known cause of toe walking. By contrast, pediatric tumors of the conus medullaris are rare. We report the case of a 28-month-old formerly extremely preterm male with global developmental delay who presented with toe walking, constipation, and asymmetric hypertonia of the lower extremities. Brain imaging revealed periventricular leukomalacia, ex-vacuo ventricular dilation, and cerebellar dysplasia consistent with a diagnosis of CP secondary to perinatal injury. Lumbar spine imaging obtained due to his worsening constipation and pain while walking demonstrated an intramedullary, well-circumscribed, contrast-enhancing lesion in the conus medullaris. Postresection pathology revealed a pilocytic astrocytoma. Following surgery, the patient had improved constipation and lower extremity tone, allowing him to walk with bilateral heel strike. His symptomatic improvement supported the contribution of the tumor to his bowel dysfunction and gait abnormality.

This case of comorbid CP and conus pilocytic astrocytoma in a child with toe walking supports careful consideration of possible concurrent neurologic pathologies in the setting of atypical history and physical exam findings, such as pain while walking and bowel/bladder dysfunction. A higher degree of suspicion and consideration of parental report of pain while walking is especially important in cases in which the patient's ability to report subjective symptoms, such as pain, subtle bowel/bladder dysfunction, and sensory changes, is limited.

Keywords

toe walking - conus tumor - astrocytoma - cerebral palsy - prematurity


Publication History

Received: 18 June 2023

Accepted: 17 December 2023

Article published online:
19 February 2024

© 2024. Thieme. All rights reserved.

Georg Thieme Verlag KG
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