Central nervous system tumor (peds)

This page is for pediatric patients. For adult patients, see: Central nervous system tumor.

Background

  • 2nd most common pediatric cancer (20%)

Clinical Features

  • Depends on location
    • Posterior Fossa
      • Headache
        • Early morning (sleep > hypoventilation > hypercarbia > increases CNS blood flow > increased ICP)
        • Red flags also include headaches that are worse with valsalva, wakes from sleep, occur daily
      • Effortless vomiting
      • Cranial nerve palsies (especially 6th nerve)
    • Brainstem
      • Cranial nerve palsies (facial weakness, abducens palsy, dysphagia), ataxia
    • Supratentorial
    • Sellar
  • Increased ICP features
  • Features of elevated ICP (from cerebral edema, tumor bleed, or mass effect
    • Headache (from increased pressure on heavily innervated meninges)
      • Red flags: worse in the morning, worse with valsalva, wakes from sleep, daily
    • Nausea/vomiting
      • Also typically worse in the morning
    • Papilledema, dilated optic nerve
    • Cushing's triad: Bradycardia, hypertension, irregular respirations
    • Bulging fontanelle in infants
  • Seizure
  • Altered mental status, irritability, coma

Differential Diagnosis

Pediatric Headache

Evaluation

  • Head CT

Management

  • Increased ICP
    • Benzodiazepines +/- AEDs if actively seizing
    • Dexamethasone(reduce tumor capillary permeability, inflammatory cytotoxicity)- 1mg/yr of age (max 10mg)
      • Do NOT give if CNS lymphoma is in the differential
    • Elevate head of bed to 30 degrees, provide adequate sedation in intubated patients
    • Maintain cerebral perfusion (euvolemia, vasopressors if necessary)
    • Consider osmotherapy (e.g. hypertonic saline, mannitol)

See Also

References

    This article is issued from Wikem. The text is licensed under Creative Commons - Attribution - Sharealike. Additional terms may apply for the media files.