title: How do the clinical features of brain tumours in childhood progress before diagnosis?
abstract: OBJECTIVE
  To investigate the progression of the clinical features from symptom onset to diagnosis in children with brain tumours.
  
  
  METHODS
  Retrospective case note review.
  
  
  METHODS
  Sixty children with brain tumours: 27 patients from Nagoya University Hospital diagnosed between February 2004 and April 2008, and 33 patients from Anjo Kosei Hospital diagnosed between April 1995 and December 2008.
  
  
  RESULTS
  Various symptoms and signs were observed. The most common initial symptoms or signs were vomiting (24.1%), headache (17.2%), unsteadiness (10.3%), and paresis (10.3%). Sixteen patients were diagnosed based on the initial symptom or sign alone; six, at routine medical check-ups or had perinatal diagnosis; and the remaining 38, based on one or more additional features following the initial symptom. Nine of the 10 patients with headache as the initial symptom subsequently developed either vomiting (in seven) or unsteadiness with cranial nerve palsies (in two). Twelve of the 14 patients with vomiting as the initial symptom subsequently developed headache (in three), unsteadiness (in five), or other manifestations of increased intracranial pressure (in four). The remaining 14 had varied initial symptoms and combinations of symptoms and signs associated with the tumour location. The median pre-diagnosis symptomatic interval was 20.5 days. There was no significant difference in the median symptomatic interval between patients with headache or vomiting as the initial symptom and those with any neurological sign.
  
  
  CONCLUSIONS
  Paediatric brain tumours present with various initial symptoms and signs. Many are diagnosed as additional symptoms or signs develop. The clinical features exhibit several patterns of progression, which are related to the tumour location.
authors.affiliation: Department of Pediatrics, Anjo Kosei Hospital, Anjo, Japan. naokohayashi11@yahoo.co.jp
authors.forename: Naoko
authors.initials: N
authors.lastname: Hayashi
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Kidokoro
authors.forename: Yuji
authors.initials: Y
authors.lastname: Miyajima
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Fukazawa
authors.forename: Jun
authors.initials: J
authors.lastname: Natsume
authors.forename: Tetsuo
authors.initials: T
authors.lastname: Kubota
authors.forename: Seiji
authors.initials: S
authors.lastname: Kojima
mesh_terms: D000293:Adolescent; D001932:Brain Neoplasms / Q000150:complications* / Q000175:diagnosis* / Q000473:pathology / Q000503:physiopathology; D002648:Child; D002675:Child, Preschool; D018450:Disease Progression; D005260:Female; D020233:Gait Disorders, Neurologic / Q000209:etiology; D006261:Headache / Q000209:etiology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D010291:Paresis / Q000209:etiology; D012189:Retrospective Studies; D014839:Vomiting / Q000209:etiology