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Reminder of important clinical lesson
CASE REPORT
Toe walking after three: how serious could it be?
  1. Linda-Marie Ustaris1,
  2. Roberta Seidman2,
  3. Tejwant Bindra3,
  4. Ratna Basak4,5
  1. 1Med-Peds, Stony Brook University Hospital, Stony Brook, New York, USA
  2. 2Department of Pathology, Stony Brook University Hospital, Stony Brook, New York, USA
  3. 3Department of Neurology, Stony Brook University Hospital, Stony Brook, New York, USA
  4. 4Department of Pediatrics, Stony Brook University Hospital, Stony Brook, New York, USA
  5. 5Department of Pediatrics, Flushing Hospital Medical Center, Flushing, New York, USA
  1. Correspondence to Dr Ratna Basak, ratnabimalbasak{at}gmail.com

Summary

A 4-year-old girl with no significant medical or family history presented with toe walking, leg pain, unsteady gait and frequent falls for 2 months. Examination revealed upper motor neuron signs in the lower extremities. Laboratory tests were normal including creatinephosphokinase and lactate dehydrogenase. Brain and lumbar spine MRI were normal. MRI cervical and thoracic spine showed a large intradural and extradural mass arising from the right C7 nerve root, widening of the neural canal with evidence of cord compression. She underwent C6–C7 laminectomy with excision of the tumour. Pathology revealed spindle cell tumour with extensive expression of S100 protein and CD56, with Ki-67 proliferation index of 1%–2% consistent with benign schwannoma. She made an excellent recovery following surgery and physiotherapy sessions. Review of literature shows rare reported case of schwannoma prior to the third decade of life.

  • spinal cord
  • pathology
  • neurosurgery
  • paediatrics

https://doi.org/10.1136/bcr-2017-223589

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    Footnotes

    • Contributors LMU, RS and TB contributed to the writing, editing, reporting and approval of the final version of the work described in the article. L-MU has contributed to the planning, reporting and conducting of the study. TB has contributed to treating. RB has contributed to the conception, planning, designing, writing, drafting, revising it critically for important intellectual content and finally approving the version uploaded.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent Parental/guardian consent obtained.

    • Provenance and peer review Not commissioned; externally peer reviewed.