The Triad of Seizures, Hypertension, and Neuroblastoma: The First Described Case

Abstract

The combination of seizures, hypertensive encephalopathy, and neuroblastoma has not been described before. The authors report one case, which is not only of interest in its own right, but also emphasizes the importance of including blood pressure measurement in the clinical examination of children, especially when hypertension could be the cause of the symptoms.

Neuroblastoma in childhood: review and radiological findings

“…Encephalopathic symptoms may be encountered in children with NBL, and are either associated with catecholamine-induced hypertension or with an autoimmune response to the tumour [4, 8]. Metastases to the orbit or compression of the optic nerves by metastatic infiltrates may cause blindness [9].…”

Emergencies Caused by Pheochromocytoma, Neuroblastoma, or Ganglioneuroma

“…Cardiovascular events are described most frequently as emergency situations owing to catecholamine excess in neuroblastoma. Hypertensive encephalopathy accompanied by seizures [151], cardiogenic shock requiring respiratory ventilation [152], or cardiac failure [153,154] accompanied by coagulopathy and acute renal and hepatic failure [155] have all been described. Furthermore, one patient presented with a condition mimicking sepsis, with hypertension, vasoconstriction, multiorgan failure, and metabolic acidosis [156].…”

Cyclic fluctuation of blood pressure in neonatal neuroblastoma

“…9,11 The correction of hypovolemia by infusion and the α-adrenergic blockade were important for treating the cyclic blood pressure fluctuations in pheochromocytoma. [9][10][11] Catecholamine excess can induce several other complications, such as hypertension, 4,7 seizure, 12 heart failure, 7 cardiomegaly, and symptoms mimicking early-onset sepsis 13 in patients with neuroblastoma. These catecholamine-induced symptoms are usually observed on admission, but sudden hypertension and lung edema caused by the induction of anesthesia, 14 exacerbation of hypertension on the day following the first dose of chemotherapy, 4 and hypertension that developed >100 days after the initiation of chemotherapy have also been reported.…”

“…As in pheochromocytoma, the main treatment for catecholamine-induced symptoms in neuroblastoma is α-blockers followed by beta-blockers as necessary. 4,6,7,12,13 Considering the similarity of the mechanism of the present symptom to that in pheochromocytoma, 2 we selected a relatively long pretreatment period with the α-blocker before the operation to stabilize the blood pressure fluctuations and restore the underlying hypovolemia induced by the catecholamine excess. In the literature, catecholamine-induced symptoms resolved in 1 week-1 month after chemotherapy and α-blocker treatment, 4,12 after surgery, 7 or without any treatment for neuroblastoma.…”