An 11 year old MC Kelpie presented to discuss radiation therapy for a brain tumour found on work up of recent onset of seizure activity.
The first seizure noted in April 2021 was thought to be toxicity related. Subsequently 2 more seizures were observed on 3/6/2021 and he was referred to a local speciality hospital for MRI on 7/7/21.
Diagnostics and Treatment Options
MRI showed a hetergeneous contrast enhancing mass in the right ventral cerebrum consistent with a glioma compressing the right lateral ventricle. Thoracic radiographs done pre-MRI were within normal limits and blood work was unremarkable.
Keppra 500mg TID and prednisolone 10mg BID was initiated and he was referred for stereotactic radiation therapy. CT simulation was done on 22/6/2021 and treatment was delivered on 3 consecutive days between 23/6/21 to 25/6/21. Treatment was uneventful and he was sent home on 15mg prednisolone once daily with Keppra unchanged.
Recheck exam 2 weeks following SRT was unremarkable with no further seizures observed and good energy and appetite. Between 9/8/21 and 6/10/21 the prednisolone was weaned down and discontinued. Keppra was kept unchanged at all times. On 24/1/22 7months post SRT the patient continued to be seizure free. Follow up imaging was declined at this time. Several additional rechecks between 30/5/22 and on 18/10/22 were all unremarkable. On 1/2/23 the patient was still seizure free but some hind end weakness was reported. He was evaluated by a surgeon and was noted to have L4-L5 pain and delayed CPs in both hindlimbs. He returned on 6/2/23 for an MRI of lumbar spine and brain. Moderate LS degenerative changes were noted with recommendation to treat conservatively. Recheck of the brain showed near complete resolution of the previously irradiated tumour. He was last seen on recheck exam 5/7/23 approximately 25 months following SRT and continues to do well.