CNS tumors (peds)

Background

• 2nd most common pediatric cancer (20%)

Clinical Features

• Depends on location
  • Posterior Fossa
    • Headache
      • Early morning (sleep > hypoventilation > hypercarbia > incrreases CNS bloodflow > inreaced ICP)
    • Effortless vomiting
    • Cranial nerve palsies (especially 6th nerve)
  • Brainstem
    • CN deficits (facial weakness, abducens palsy, dysphagia), ataxia
  • Supratentorial
    • Headache, personality change, motor weakness, seizure
  • Sellar
    • Visual changes, hypothalamic dysfunction (DI, stunted growth, hypothyroidism)

Differential Diagnosis

Pediatric Headache

• Primary headache
  • Migraine
  • Tension
  • Cluster
• Secondary headache
  • Viral illness and fever
  • Post-traumatic
  • VP shunt malfunction
  • CO poisoning
  • Epidural hematoma
  • Subdural hematoma
  • Brain abscess
  • Pseudotumor cerebri
  • Meningitis
  • Space-occupying lesion
  • AVM
  • Sinusitis
  • Dental abscess
  • Otitis media
  • CNS tumor

Evaluation

• Head CT

Management

• Increased ICP
  • Phenytoin, benzodiazepines if actively seizing
  • Dexamethasone 1mg/yr of age (max 10mg)
    • Do NOT give if CNS lymphoma is in the differential

See Also

• Herniation Syndromes
• Elevated ICP

References

Authors

Jordan Swartz, C Urban, Ross Donaldson, Claire, Daniel Ostermayer, Neil Young