title: Delay in the diagnosis of paediatric brain tumours.
abstract: The pre-diagnostic period of 252 children (median age 6.3 years, range 0-16.9 years) with primary brain tumours was assessed to analyse their clinical presentation and reasons for any delay in diagnosis. The median pre-diagnostic symptomatic interval (PSI) was 60 days (range 0-3010 days) with a parental delay of 14 days (range 0-2310 days) and a doctor's delay of 30 days (range 0-3010 days). Only 33% of brain tumours were diagnosed within the 1st month after the onset of signs/symptoms. PSI correlated significantly with patients' age and tumour histology, but not with gender, year of diagnosis or tumour location (supratentorial hemispheric, supratentorial midline, infratentorial). In children older than 2 years, most common initial signs/symptoms were headache, nausea/vomiting, seizures, squint/diplopia, ataxia and behavioural changes. In children younger than 2 years, most common initial signs/symptoms were seizures, vomiting, head tilt and behavioural changes. These signs/symptoms are by no means pathognomonic features of brain tumours, making the diagnosis in the early course often difficult.
  
  
  CONCLUSIONS
  given the fact that the vast majority of patients (88% in the present study) develop further signs/symptoms, a high level of awareness, a detailed medical history and repeated correctly interpreted neurological examinations should lead to an earlier diagnosis and to a higher probability of total tumour resection.
authors.affiliation: Department of Oncology, University Children's Hospital Zurich, Steinwiesstrasse 75, 8032 Zurich, Switzerland.
authors.forename: Milana
authors.initials: M
authors.lastname: Dobrovoljac
authors.forename: Heinz
authors.initials: H
authors.lastname: Hengartner
authors.forename: Eugen
authors.initials: E
authors.lastname: Boltshauser
authors.forename: Michael A
authors.initials: MA
authors.lastname: Grotzer
mesh_terms: D000293:Adolescent; D000328:Adult; D001932:Brain Neoplasms / Q000175:diagnosis* / Q000503:physiopathology; D002648:Child; D002675:Child, Preschool; D005260:Female; D006261:Headache; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007427:Intracranial Pressure; D008297:Male