Pediatric emergency medicine trisk 2676 2676

CNS tumors span a wide range of clinical presentations. The most critical goal is the
timely identification and management of cord compression and increased ICP. The
goal of early identification of CNS tumors needs to be balanced against exposure to
ionizing radiation from CT given that many children present with nonspecific
symptoms including headache and/or vomiting. Careful recognition of atypical
features and/or concerning associated signs or symptoms can assist in decision
making regarding advanced imaging.
CLINICAL PEARL AND PITFALLS
Clinical clues for increased ICP may include a bulging fontanel in infants,
or headache with early morning vomiting in older children.
Measurement of sodium levels is particularly important in patients with
CNS tumors.

Current Evidence
Brain tumors represent the most common solid tumor in the pediatric population and
the second most frequent pediatric cancer overall. There are approximately 2,000
new malignant brain tumors diagnosed annually in children. These tumors can affect
children and adolescents of any age group, but the peak incidence is in children 5 to
10 years old. Supratentorial tumors are more common in children younger than 1
year and older than 10 years. Infratentorial lesions are more common between ages
of 1 and 10 years. Unlike in adults, brain tumors in children are usually primary, not
metastatic. Since tumor location usually drives the presenting signs and symptoms,
this is the most useful categorization in the ED ( Table 98.4 ).

Clinical Considerations
Clinical Recognition
Some of the symptoms of brain tumors in children are nonspecific, and
nonlocalizing complaints occur with a variety of tumor types. Examples include
headache, altered behavior, vision changes, altered growth or weight, somnolence,
and altered school performance. The diagnosis of brain tumor may be delayed in
such patients. Once patients develop signs and symptoms more easily referred to the

CNS, their presentations tend to hinge on the tumor location ( Table 98.4 ).
Infratentorial tumors may present with cranial nerve deficits, such as facial nerve
palsies, dysphagia, or paresis of cranial nerve VI, causing diplopia or strabismus.
Ependymomas of the fourth ventricle may present with hydrocephalus and increased
ICP. Cerebellar lesions can cause truncal ataxia and a reeling gait when located on
the midline. When only one cerebellar hemisphere is involved, patients may display