Neurologist's First Review

This is a copy of a letter sent from Tara's Neurologist to Tara's GP on 5th February 2010:

Dear Dr Nalletamby

Diagnosis:
    Pilocytic astrocytoma in the posterior fossa associated with gross acute hydrocephalus, VP shunt inserted, diagnosed in August 2009.

Tara was seen for her first review in the Brain Tumour Service today, 5 February 2009, following her presentation to King's College Hospital back in August with symptoms of hydrocephalus found to be secondary to a large posterior fossa tumour.

I was pleased to hear that her initial postoperative scan organised by Mr Bassi had revealed an almost complete resection, although there is a possible small rim within the cavity. Unfortunately, Tara had revealed a CSF leak postoperatively and had required a VP shunt which is currently in situ and appears to be working well.

Tara now appears fit and well, apart from an intermittent convergent squint on the left eye which is associated with a full range of eye movement and no evidence of a sixth nerve palsy now.

She continues to be under the Brighton Ophthalmology Team who had initially seen her through her presentation. The family today have requested personal reviews by Dr Vickers, as they feel that the Ophthalmology surveillance was occurring with a different team for quite some time before her symptoms acutely worsened.

On examination today, Tara's signs had improved considerably when compared to her review on the Paediatric Neurology Ward. Her head circumference today was 49.8cm, with a weight of 12.7Kg and height of 85.7cm. Her blood pressure was 90/50. She has now only a mild cerebella intention tremor bilaterally and her gait examination was within normal limits. She has a right hand preference and a reluctance to use the left side, but can do so adequately when encouraged to do so. She was able to build a tower of three blocks and perform some fine motor bimanual tasks.

We have explained to the parents that she will need to be seen in the Brain Tumour Clinic here on a six-monthly basis for the time being to monitor the small residual within the cavity and also to ensure her development continues to remain within a normal trajectory in the near future. It may be possible to transfer her into the Brighton Clinic with time, but we have persuaded them of the benefits of coming to King's College Hospital in the near future. A follow-up scan has been booked for six months time with a clinic immediately following this in September.

Your Sincerely

Dr Tammy Hedderly
Consultant Paediatric Neurologist