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General Pediatric Brain Tumor

 

 

Presentation

Childhood brain tumors may present in many ways, but there are some common features which should alert the clinician to the possibility of a brain tumor:

Children may present with:

  • Signs and symptoms of raised intracranial pressure
  • Localizing signs
  • Non-localizing signs

 

General Overview of CNS Tumor Presentation:

Problem

Possible Presentation

Raised intracranial pressure

Headache, vomiting, lethargy

Papilledema - with swelling and hemorrhage of the optic disc on fundoscopy:

Cranial nerve abnormalities:

 

The most commonly 6th (VI) cranial nerve palsy:

 

This is a "false localizing sign".

 

Hydrocephalus causes compression of the 6th cranial nerve at the petroclival ligament, resulting in diplopia, medial deviation of the affected eye and lateral gaze paresis.

 

 

Left lateral rectus (6th cranial nerve palsy)

 

Localizing symptoms and signs due to tumor infiltration into normal structures

Optic pathways:

  • Visual loss

Cerebellum:

  • Ataxia
  • Defects in co-ordination
  • Nystagmus
  • Abnormal speech.

Brain stem:

  • Cranial neuropathy
  • Long tract signs

Supratentorial brain:

  • Hemiparesis/limb weakness from cerebral cortex involvement
  • Hemisensory loss
  • Visual field abnormalities
  • Cognitive/learning difficulties
  • Seizures

Deep midline tumors:

  • Endocrinopathies
  • Visual acuity and visual field abnormalities
  • Parinaud’s syndrome (paralysis of upgaze, loss of pupillary reflex to light, eyelid retraction and nystagmus)
Non-localizing symptoms and signs

Seizures

 

General malaise

Changes in behavior

Loss of previously acquired developmental milestones

 

Specific tumor types usually present in characteristic ways which depend for the most part on tumor location.

 

General Overview of the presentation of common types of pediatric brain tumor:

Tumor Type Location

Presentation

Medulloblastoma

 Posterior fossa

Tumor grows rapidly - short history of illness.

 

Raised ICP causes:

Headache, vomiting, lethargy

 

Localizing signs:

Tumors arise in the cerebellum and are associated with loss of balance (ataxia, tremor and problems with co-ordination)

 

 

Ependymoma

 Usually posterior fossa

Raised ICP causes:

Headache, vomiting, lethargy

 

Localizing signs:

Tumors arise in the cerebellum and are associated with loss of balance (ataxia, tremor and problems with co-ordination)

Intrinsic Diffuse Brain stem glioma Usually brainstem is diffusely involved (often the pons)

Tumor grows rapidly - short history of illness.

 

Cranial nerve palsies (6th nerve palsy is quite common)

Limb weakness (long tract signs)

Loss of co-ordination (not prominent)

 
Focal Brain stem glioma Focal brain stem involvement

Much longer history than the diffuse brain stem tumors.

 

Difficulty swallowing (repeated episodes of pneumonia)

 

Nystagmus and some loss of co-ordination.

Optic pathway glioma Involvement of the optic nerve or chiasm or hypothalamus

Longer history of

Visual defects

 

Nystagmus

 

Diencephalic syndrome

Pineal tumors Dorsal midbrain involved Parinaud's syndrome

 

 

 

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