The presenting features of brain tumours: a review of 200 cases
- 1Department of Paediatrics, Southampton General hospital, Southampton, UK
- 2Department of Paediatrics, Royal Hampshire County Hospital, Winchester, UK
- 3Community Paediatrics, Portsmouth NHS Hospital Trust, Portsmouth, UK
- 4Paediatric Neurology, University of Southampton, Southampton General Hospital, Southampton, UK
- Correspondence to:
Dr C R Kennedy
Paediatric Neurology, University of Southampton, Mailpoint 21, Child Health, Southampton General Hospital, Southampton SO16 6YD, UK;
- Accepted 30 January 2006
- Published Online First 17 March 2006
Objective: To determine the presenting features of brain tumours in children.
Design: Retrospective case note review.
Setting: Paediatric and neurosurgical services at the Wessex Neurology Centre and Southampton General Hospital, UK.
Patients: 200 patients presenting with a CNS tumour between 1988 and 2001.
Results: The commonest first presenting symptoms were headache (41%), vomiting (12%), unsteadiness (11%), visual difficulties (10%), educational or behavioural problems (10%), and seizures (9%). The commonest symptoms occurring at any time were headache (56%), vomiting (51%), educational or behavioural problems (44%), unsteadiness (40%), and visual difficulties (38%). Neurological signs were present at diagnosis in 88%: 38% had papilloedema, 49% cranial nerve abnormalities, 48% cerebellar signs, 27% long tract signs, 11% somatosensory abnormalities, and 12% a reduced level of consciousness. The median symptom interval was 2.5 months (range 1 day to 120 months). A short symptom interval was significantly associated with high grade tumours and patient age of 3 years or younger.
Conclusions: The well known predominance of headache in children with CNS tumours is confirmed. Visual, behavioural, and educational symptoms were also prominent. With the exception of seizures, every initial symptom was accompanied by other symptoms or signs by the time of diagnosis. Questions about visual symptoms and educational or behavioural difficulties, as well as the more widely recognised symptoms of raised intracranial pressure and motor dysfunction, are important in the diagnosis of brain tumours, as are vision assessment and the appropriate plotting of growth and head size.
Published Online First 17 March 2006
↵* Ashok Nathwani, who was involved in the early stages of this study, tragically died in the earthquake in Gujarat in 2001 while undertaking paediatric liaison work in India.
Competing interests: none declared