Elsevier

Brain and Development

Volume 32, Issue 8, September 2010, Pages 636-641
Brain and Development

Original article
How do the clinical features of brain tumours in childhood progress before diagnosis?

https://doi.org/10.1016/j.braindev.2009.10.001Get rights and content

Abstract

Objectives

To investigate the progression of the clinical features from symptom onset to diagnosis in children with brain tumours. Design: Retrospective case note review. Patients: 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. Conclusion: 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.

Introduction

Brain tumours are the most common solid tumours in children. Approximately 2200 children are newly diagnosed with malignant brain tumours each year in USA [1]. Despite recent advances in neurosurgery, oncology, and radiology, the overall survival rate of affected patients has not improved.

Studies have reported that it takes several months from symptom onset to the diagnosis of a brain tumour in childhood [2], [3], [4], [5], [6], [7], [8], [9]. Many factors are associated with this delayed diagnosis, including the variety of non-specific symptoms such as headache, vomiting, and behavioural problems. Headache and vomiting are the most common symptoms of a brain tumour in children and adults. Seizures, paralysis of the extremities, and visual disturbance are other common features of brain tumours. This variety of symptoms is explained by the localisation of brain function and tumours. Previous reports have studied mainly the frequency of symptoms in patients with a particular histology or localisation of brain tumour [10], [11]. However, it is not clear how the symptoms and signs of brain tumours progress chronologically in each patient. This information is important because most affected patients are not diagnosed from the initial symptom alone, but rather as additional symptoms or signs develop. Therefore, clarification of the sequence of symptoms and signs in an individual will help clinicians to make an earlier diagnosis of brain tumour, which may lead to a better prognosis.

This study examined the progression of clinical features from onset to diagnosis in children with brain tumours.

Section snippets

Methods

Twenty-seven patients diagnosed with brain tumours between February 2004 and April 2008 at Nagoya University Hospital and 33 diagnosed between April 1995 and December 2008 at Anjo Kosei Hospital were enrolled in this study. Patients with benign tumours such as dysembryoplastic neuroepithelial tumour, ganglioglioma, gangliocytoma, and neurofibromatosis were excluded from this study. Ethical approval was obtained from the Clinical Research Ethics Committee of the Anjo Kosei Hospital and Nagoya

Results

The median age at diagnosis was 5.8 years (range, 1 day to 15 years). Thirty-five of the 60 patients were 4 years old or older. The male to female ratio was 48:52 (29 males, 31 females). The pathological diagnosis was embryonal tumours (including medulloblastoma, primitive neuroectodermal tumours, and atypical teratoid rhabdomyoma tumours) in 13; astrocytoma in 11; germ cell tumours in seven; ependymoma in four; choroid plexus papilloma in three; craniopharyngioma in three; and both

Discussion

This paper examined the progression of symptoms and signs from onset to diagnosis in children with brain tumours, and detected the presence of several clinical progression patterns according to the initial symptom or sign. These patterns of progression were strongly associated with tumour location. It is important to know the clinical course before diagnosis, because many patients with brain tumours are not diagnosed from a single symptom alone and present with non-specific symptoms at onset [2]

Conflict of interest

We have no conflict of interest in relation to this manuscript.

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