Discussion: Remain Open to All Possibilities
The tumor was found to be a ganglioneuroma, a rare tumor that contains neuronal tissue. In the course of attacking the tumor cells, the patient's immune system also attacked healthy brain cells and caused her epilepsy and ataxia, a process known as neurologic paraneoplastic syndrome. If the tumor had been a type that is typically linked to neurologic symptoms, such as an ovarian tumor, it would likely have been removed immediately. However, the adrenal location of a tumor in this age group is not commonly associated with these kinds of symptoms.
This case underscores the importance of keeping our minds open to all possibilities. Even when a patient has had symptoms for many years and has undergone extensive workup, we should persist in looking for the primary etiology. In this case, taking another close look at old tests solved the mystery.
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Cite this: A Surprising Case of Super-Refractory Pediatric Status Epilepticus - Medscape - Oct 29, 2015.