Source: Wilne SH, Ferris RC, Nathwani A, et al.
The presenting features of brain tumors: a review of 200 cases.
Arch Dis Child. 2006;91:502–506
The presenting features of brain tumors in 200 children diagnosed between 1988 and 2001 were determined by retrospective chart review at the pediatric and neurosurgical services of the Wessex Neurology Centre and Southampton General Hospital, UK. Mean age at presentation was 7.4 years (range 15 weeks to 17 years). The male/female ratio was 4:3. The first symptoms in order of frequency were headache in 41%, vomiting (12%), ataxia (11%), visual problems (10%), educational or behavioral disorders (10%), and seizures (9%). Headaches were nocturnal or occurred in early morning in 43 (61%) and were continuous in 13 (18%). A diagnosis of migraine was made in 14 (13%) and tension headache in 8 (7%). Of 38 children with school problems, 12 had impairments in reading, writing, memory, and concentration, and poor attendance. Visual disturbances were present in 76 (38%) patients and included diplopia in 30 and blurred vision in 27. Seizures occurred in 30 (15%) patients; in 19 children the seizures were focal in nature.
One or more abnormal neurologic signs was found in 175 (88%) children at presentation and included papilledema in 66 (38%), cranial nerve abnormalities in 86 (49%), cerebellar signs in 84 (48%), long tract signs in 47 (27%), and impaired consciousness in 21 (12%). Of 24 children with no neurologic findings at diagnosis, 17 (71%) had seizures (focal in 14). Of the remaining 7, 4 were >3 years of age. Two had nocturnal or early morning headache and 2 had headache with vomiting or visual symptoms. Three of these children had abnormal endocrine function (and underlying craniopharyngioma) and the remaining child had "clumsiness" secondary to hydrocephalus (and underlying tectal glioma). Of the 3 children between 2–3 years of age, 1 child with neurofibromatosis type 1 presented with vomiting and behavior change, 1 had unsteadiness for 1 month’s duration, and 1 was under evaluation for a shunt malfunction. In the 42 children who were <3> and seizure were less common than in older patients (12% vs 68% and 7% vs 17%, respectively), whereas behavioral problems such as lethargy were more common (48% vs 30%). The median duration of symptoms before diagnosis was 2.5 months (range 1 day to 120 months). Children aged <3> symptom interval prior to diagnosis than older patients (1 vs 3 months). High-grade tumors were diagnosed more rapidly after onset of symptoms than low-grade tumors (median, 1.5 vs 4 months), and infratentorial tumors sooner than supratentorial tumors (median, 2 vs 4 months).
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