OLFU 2023

Central Nervous System Tumors in Children

Lecturio – Dr. Brian Alverson | 24 February 2021 | Topic 1 – Second Sem
3. Pineal lesions / Optic Chiasms Lesions
I. PATHOLOGY – Defects in pupil constriction
– Inability to perform upward gaze (Parinaud Syndrome)
– Second most common pediatric malignancy in children
– 20% all cases of children cancer
– Younger patients are more likely to have embryonal tumors C. Diagnostic Testing
(medulloblastoma) vs older patients
– Generally, a sporadic problem, without risk factor or cause Radiologic Findings
– Although, some genetic syndromes may predispose patients to – MRI with gadolinium: imaging of choice, requires sedation in
development of CNS tumors younger children
– MRI of the spine: for the possibility of metastasis to the spine, or
II. CNS TUMORS DIAGNOSIS other non-tumor cause like acute disseminating encephalomyelitis
– CT scan can be done early or before doing a lumbar puncture for
A. Good History Taking possibility of meningitis to avoid increase in ICP to be depressurized
after the foramen magnum and result in herniation.
– Once diagnosis of brain tumor has been done, we do a Lumbar
1. Historical Findings – Initial Signs of Elevated ICP Puncture (LP) for CSF cytology
– Signs and Symptoms  Older patients are preferred to be in the sitting position
 Historical findings of CNS tumors in general depend on the  Younger or infants in the lying position
location of the tumor in the brain  If looking for an increased ICP, manometer is preferably used
 Symptoms may result from an increase in the intracranial in lying position
pressure (ICP) (*except pituitary adenomas which generally  CSF beta-hCG and AFP (+ = teratomas)
does not present as such).
 However, most tumors can cause an increase in ICP and may
present with a classic finding of: III. QUIZ
 Morning headache 1. A patient presents with headache for the past three weeks. Which of the
 Morning emesis following historic finding is most concerning for the possibility of tumor?
o The child has been lying down all night and there is a. Headache that is worse in the morning
increase pressure because he/she has been in a b. Headache without associated focal findings
resplendent pose and once he gets up and moves
c. Headache without nausea or vomiting
around, the pressure may reduce slightly.
 Lethargy d. Unilateral throbbing headache in the temporal region
 Other indirect signs e. Headache that is preceded by seeing flashing lights
o Poor school performance
o Fatigue 2. Which of the following is not a characteristic of diencephalic
o Behavioral change syndrome?
o Weight loss/gain a. Weight gain
o Increased clumsiness b. Hyperactivity
o Walking difficulty c. Normal linear growth
 All of these can be a sign of a problem in the intracranial vault d. Seen in tumors of the hypothalamic region
 Patients with focal seizures with prolonged postictal e. Increased appetite
paralysis may be a sign of having an increased ICP.
3. Which of the following is the most common type of brain cancer in
B. Good Physical Examinations
younger children?
1. Infratentorial Tumors – Signs of ICP a. Neuroblastoma
b. Craniopharyngioma
– Cranial nerves are very particular to evaluate as cranial nerve palsies
are common with brainstem lesions c. Ependymoma
– Papilledema d. Retinoblastoma
– Ataxia e. Medulloblastoma
– Facial droop/weakness
– Hearing loss REFERENCES
– Diplopia, esp in patients with pituitary lesions
1. Dr. Brian Alverson, MD – Lecturio
https://fatima.lecturio.com/#/lecture/c/8480/29444
2. Supratentorial Tumors
– Focal Symptoms:
 Hemiparesis
 Hemisensory loss
– Hyperreflexia
– Visual defects
– Seizures
– Hypothalamic tumors: diencephalic syndrome
 Euphoria, hyperphagia, anorexia

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