Central Nervous System Tumors in Children

by Brian Alverson, MD

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    00:01 In this lecture, we're going to review central nervous system tumors in children.

    00:07 So, in children, CNS tumors are the second most common pediatric malignancy.

    00:14 About 20% of all cases of childhood cancer are CNS masses and younger children are more likely to have embrional tumors such as medulloblastoma compared to older patients.

    00:28 This is generally a sporadic problem.

    00:30 It's without real risk factors or causes.

    00:33 It's just extraordinary bad luck, although certain genetic syndromes may predispose patients to development of CNS tumors.

    00:42 So, to diagnose it as a CNS tumor, we have to take a good history, do a physical exam, and do some diagnostic imaging.

    00:50 Let's start with the history.

    00:52 So, the historical findings of CNS tumors in general depend on the location of the tumor in the brain.

    01:00 Symptoms may result from an increased intracranial pressure.

    01:06 I would say the exception being pituitary adenomas which generally don't do that.

    01:11 However, most other tumors can cause an increase in ICP which will present with the classic finding of morning headache and morning emesis.

    01:22 If you think about it, the child's been lying down all night and there's increased pressure because they've been in a resplendent pose and once they get up and move around, the pressure may reduce slightly.

    01:32 These patients may also be lethargic or sleepy, or feel out of it.

    01:37 We may see other signs indirectly such as poor school performance, fatigue, behavioral changes, weight gain or weight loss, increased clumsiness, or walking difficulty.

    01:51 So all of these can be signs of a problem in the intracranial vault.

    01:56 Also, patients with focal seizures or with prolonged postictal paralysis, that may be a sign of increased ICP.

    02:05 So, then we have to do a good physical exam and in particular, the cranial nerves are very important to evaluate.

    02:14 As cranial nerve palsies are fairly common with brainstem lesions.

    02:19 You may also see papilledema, you may see ataxia, you may see a facial droop or weakness which is really a cranial nerve palsy, you may see hearing loss, and you may see diplopia, especially diplopia in patients with a pituitary lesion.

    02:37 You can also find focal symptoms if it's a little bit higher up such as hemiparesis or a hemisensory loss.

    02:45 You may notice hyperreflexia or visual defects or seizures, especially focal seizures are concerning, and any hypothalamic tumor can present with a diencephalic syndrome.

    02:59 The diencephalic syndrome is euphoria, hyperphagia, and anorexia.

    03:05 Okay. Let's talk about pineal lesions and optic chiasm lesions very briefly.

    03:14 These can cause defects in pupillary constriction and patients may have an inability to look upward.

    03:23 This is called the Parinaud syndrome.

    03:25 Also, we will do some diagnostic testing to rule out CNS tumors.

    03:33 So the MRI with gadolinium is the imaging of choice.

    03:38 It does require sedation in younger children.

    03:41 Generally, we will also get an MRI of the spine because generally there may be metastasis to the spine or this might not be a tumor, it could be something like acute disseminated encephalomyelitis for example which presents with diffuse disease.

    03:56 You may early, if you're worried, get a CAT scan.

    04:01 You might want to do a CAT scan, for example, before you do a lumbar puncture if you are thinking this patient might have meningitis because you don't want to cause an increased ICP to be depressurized after the foramen magnum and result in a herniation.

    04:16 So, we usually will do a CSF though once we've made the diagnosis of brain tumor to try and get cytology or cells.

    04:25 So, there are a multiple ways, you can sit patients for a lumbar puncture.

    04:30 Generally, for older patients we prefer the sitting position.

    04:34 For younger patients or babies, you might do a lying down position.

    04:37 Doesn't really matter except remember, if you're looking for an increased ICP, you're gonna wanna use your manometer in the lying down position.

    04:46 We will send this CSF for beta-hCG and AFP which may be positive in teratomas which can present in the brain.

    About the Lecture

    The lecture Central Nervous System Tumors in Children by Brian Alverson, MD is from the course Pediatric Oncology. It contains the following chapters:

    • Central Nervous System Tumors
    • Infratentorial Tumors
    • Diagnostic Testing

    Included Quiz Questions

    1. Headache that is worse in the morning
    2. Headache that is preceded by seeing flashing lights
    3. Headache without nausea or vomiting
    4. Unilateral throbbing headache in the temporal region
    5. Headache without associated focal findings
    1. Weight gain
    2. Increased appetite
    3. Seen in tumors of the hypothalamic region
    4. Normal linear growth
    5. Hyperactivity
    1. 20%
    2. 10%
    3. 2%
    4. 30%
    5. 75%

    Author of lecture Central Nervous System Tumors in Children

     Brian Alverson, MD

    Brian Alverson, MD

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    Excellent lecture
    By Jalil Z. on 23. August 2020 for Central Nervous System Tumors in Children

    Excellent lecture as usual. Explains many relevant findings to look for during the clinical exam. Thanks¨