A three-year-old child in foster care died from high-grade pontine glioma, an aggressive brain tumour. The child had presented with severe developmental delay, behavioural problems, and global developmental concerns attributed to neglect and prenatal drug/alcohol exposure. Early diagnosis was unlikely given these confounding factors and absence of specific neurological signs pointing to a brain tumour. When found unresponsive, imaging revealed advanced disease with hydrocephalus and tonsillar herniation. Clinical management in hospital was appropriate; multidisciplinary teams correctly determined treatment would be futile. The coroner's investigation found no areas of concern with medical care provided. Key lesson: aggressive pontine gliomas present diagnostic challenges, particularly in children with developmental and behavioural issues masking neurological symptoms.
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