title: Interval between onset of symptoms and diagnosis of medulloblastoma in children: distribution and determinants in a population-based study.
abstract: Hospital-based studies have reported long delays in the diagnosis of paediatric brain tumours. Our objective was to describe the duration between onset of symptoms and diagnosis of medulloblastoma in children and study their clinical determinants in a population-based study. This retrospective cohort study included all paediatric medulloblastoma from a region of France from 1990 to 2005. The median interval from symptom onset until diagnosis for these 166 patients was 65 days and did not decrease during the study period. The most frequent manifestations were: vomiting (88%), headaches (79%), psychomotor regression (60% of children under 3 years), psychological symptoms (27%), strabismus (26%), and asthenia (25%). For one third of the children under 3 years, the diagnosis was made only after life-threatening signs of intracranial hypertension appeared. The prediagnosis interval was significantly longer (median 91 vs. 60 days, p = 0.001) in children with psychological symptoms (27%). Causes for intervals that exceeded the median (65 days) included inconsistent (25%) or late (36%) combination of headaches and vomiting, a period of spontaneous symptom remission (14%-20%), no (24%) or late (57%) neurological signs, psychological symptoms (35%), and a normal neurological examination (27%). Time to medulloblastoma diagnosis in children remains fairly long, despite advances in imaging. Primary-care physicians must be suspicious not only of suggestive neurological signs, but also of non-specific symptoms that persist or are multiple. A meticulous neurological examination and cerebral imaging for such patients might facilitate earlier diagnosis.
authors.affiliation: Department of Paediatric and Adolescent Oncology, Institut Gustave Roussy, Villejuif, France. jfbrasme@gmail.com
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Brasme
authors.forename: Martin
authors.initials: M
authors.lastname: Chalumeau
authors.forename: François
authors.initials: F
authors.lastname: Doz
authors.forename: Brigitte
authors.initials: B
authors.lastname: Lacour
authors.forename: Dominique
authors.initials: D
authors.lastname: Valteau-Couanet
authors.forename: Stephan
authors.initials: S
authors.lastname: Gaillard
authors.forename: Olivier
authors.initials: O
authors.lastname: Delalande
authors.forename: Nozar
authors.initials: N
authors.lastname: Aghakhani
authors.forename: Christian
authors.initials: C
authors.lastname: Sainte-Rose
authors.forename: Stéphanie
authors.initials: S
authors.lastname: Puget
authors.forename: Jacques
authors.initials: J
authors.lastname: Grill
mesh_terms: D002528:Cerebellar Neoplasms / Q000175:diagnosis*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D057210:Delayed Diagnosis / Q000706:statistics & numerical data*; D005260:Female; D005602:France; D006801:Humans; D008297:Male; D008527:Medulloblastoma / Q000175:diagnosis*; D009460:Neurologic Examination; D012189:Retrospective Studies; D013997:Time Factors; D014057:Tomography, X-Ray Computed