The presenting features of brain tumours: a review of 200 cases.
OBJECTIVE
To determine the presenting features of brain tumours in children.


METHODS
Retrospective case note review.


METHODS
Paediatric and neurosurgical services at the Wessex Neurology Centre and Southampton General Hospital, UK.


METHODS
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.
Department of Paediatrics, Southampton General hospital, Southampton, UK.
S H
SH
Wilne
R C
RC
Ferris
A
A
Nathwani
C R
CR
Kennedy
D000293:Adolescent; D001932:Brain Neoplasms / Q000150:complications* / Q000175:diagnosis; D002648:Child; D002653:Child Behavior Disorders / Q000209:etiology; D002675:Child, Preschool; D005260:Female; D006261:Headache / Q000209:etiology; D006801:Humans; D007223:Infant; D008297:Male; D009483:Neuropsychological Tests; D014474:Unconsciousness / Q000209:etiology; D014786:Vision Disorders / Q000209:etiology; D014839:Vomiting / Q000209:etiology