Central nervous system tumors in children–understanding the clinical manifestations and differential diagnosis Flashcards
What are the most common solid tumors in children?
CNS tumors
In children who died of cancer and what is the leading cause of tumors?
CNS tumors
What is the most common presenting symptom in a child with CNS tumor?
Headache
In infants and young children less than 4 years of age what are some of the presenting signs and symptoms suggestive of CNS tumor?
Headache, delayed closure of cranial sutures, bulging fontanelles, macrocephaly, irritability, nausea, emesis, weight loss, poor growth, loss of milestones for developmental delay, seizures, head tilt/torticollis.
In older children what are some of the presenting signs and symptoms of a CNS tumor?
Headache, nausea, emesis, abnormal gait, poor coordination, seizures, papilledema, cranial nerve palsies, hemiplegia, altered consciousness.
How does a CNS tumor present in the hypothalamus?
Endocrine related diseases such as diabetes insipidus or slow growth
How does the CNS tumor present in the optic pathway?
Visual impairment, hemianopsia, proptosis, nystagmus
How does a CNS tumor present in the cerebral cortex?
Headache, seizures, abnormal speech, memory deficits, personality changes, hyperreflexia.
How does a CNS tumor present posterior fossa?
Nausea and emesis likely, headache, ataxia, abnormal gait or poor coordination, papilledema.
How does the CNS tumor present in the brainstem?
Abnormal gait, difficulties with coordination, nystagmus, cranial nerve deficits, headache (uncommon), papilledema, torticollis in children.
How does the CNS tumor present in the spinal cord?
Pain and or weakness corresponding to level of lesion, urinary bowel incontinence, abnormal gait, torticollis in children.
Even though headaches are the most common presenting symptom for brain tumor how often are they actually associated with CNS tumor?
Present in only about one third of children with CNS tumors
Describe the classic pattern of headaches associated with a brain tumor?
Early morning headaches awakening the child from sleep or causing headache upon awakening. Headaches are often relieved by vomiting. In young children they may present as irritability, CNS tumor associated headaches are thought to be related to increasing ICP so may have other symptoms including emesis, visual impairment, growth impairment, lack of coordination or unsteady gait, or changes in school performance.
What cluster of symptoms may be present and patients with posterior fossa tumors?
Recurrent or persistent nausea/emesis, even with isolated nausea and vomiting.
What symptoms are associated with supratentorial lesions?
Seizures
What cluster of symptoms are associated with brainstem tumors?
Cranial nerve palsies, facial palsy, drooling, double vision, or swallowing difficulties. Young children may cover an eye or 1 eye or tilt her head to alleviate double vision.
What cluster of symptoms are associated with posterior fossa or cervical spine cord tumor?
Torticollis/head tilt, sudden onset of atraumatic torticollis may be the presenting sign.
What other symptoms may be associated with posterior fossa tumors?
Papilledema
What cluster of symptoms are consistent with craniopharyngioma’s or midline tumors?
Endocrinopathies, diabetes insipidus, growth impairment, precocious puberty, or obesity.
What cluster of symptoms may be present for CNS tumors in the cortex, brainstem, or spine?
Early hand preference which may indicate unilateral weakness or loss of coordination.
What CNS tumors may manifest as skin pathology?
Neurofibromatosis type I have axillary freckling and café au lait macules. These patients have an increased risk of optic pathway gliomas. Patients with neurofibromas type II are at increased for developing meningiomas and acoustic schwannomas. Patients with tuberous sclerosis complex are at increased risk to develop subependymoma giant cell tumors.
What is the differential diagnosis for CNS tumors?
Brain abscesses
Intracranial hemorrhage
Hydrocephalus (nonneoplastic)
Aneurysm
AV malformations
Developmental and or behavioral problems
Viral gastroenteritis
Migraine headaches, etc.
