Presentation of childhood CNS tumours: a systematic review and meta-analysis

Wilne, Sophie; Collier, Jacqueline; Kennedy, Colin; Koller, Karin; Grundy, Richard G.; Walker, David

doi:10.1016/s1470-2045(07)70207-3

Cited by 333 publications

(284 citation statements)

References 77 publications

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“…There were, however, marked differences in the relative frequency and rank of individual symptoms. Although headache predominates as the most frequently reported symptom in hospital-based studies, reported for 33% to 41% of children, 5,6 our primary care data identified vomiting (in the absence of diarrhea or gastroenteritis) as the most common symptom. It was recorded at least once for almost three quarters of the case children between birth and diagnosis but also, it is important to note, for 15% of the unaffected controls.…”

Section: Discussionmentioning

confidence: 67%

“…The remainder of the top 5 symptoms for case children (headaches, visual difficulties, unsteadiness, and anorexia) were also recorded more frequently than has been reported previously from hospital-based studies. 5,6 This may reflect differences in a Regression models were adjusted for age at diagnosis, gender, and region of residence and for correlation between repeated observations over time by using generalized estimating equations. b See Table 1.…”

Section: Discussionmentioning

confidence: 99%

“…Each event was classified according to whether a "relevant" sign or symptom was recorded, and the number of relevant signs and symptoms recorded at each event was determined. Relevant signs and symptoms were defined as those that might be suggestive of a brain tumor, a judgment based on a combination of clinical experience and previous reports in the literature 5,6 ( Table 1). The 21 relevant signs and symptoms identified ranged from common childhood symptoms with a variety of possible causes, not necessarily neurologic (eg, vomiting), to unusual symptoms sometimes observed at the time of brain tumor diagnosis (eg, head tilt), to signs almost certainly having an intracranial cause (eg, papilloedema).…”

Section: Datamentioning

confidence: 99%

“…2 Nonetheless, because of the impact of diagnosis on families, including perceived delays in diagnosis, 3,4 GPs need evidence-based information on early presenting signs and symptoms to help inform their decisionmaking. Whereas good information on symptom clusters seen in secondary care at the time of diagnosis is now available, 5,6 data on presentation in primary care are poor and subject to recall bias. Previous studies have included only children diagnosed with central nervous system tumors, with the exception of 1 small study of 22 cases.…”

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confidence: 99%

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Brain Tumor Signs and Symptoms: Analysis of Primary Health Care Records From the UKCCS

et al. 2010

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WHAT'S KNOWN ON THIS SUBJECT:Good information on symptom clusters seen in secondary care at the time of brain tumor diagnosis is now available, but information on how children present in primary care is poor and subject to recall bias. WHAT THIS STUDY ADDS:This report describes signs and symptoms recorded in children's general practitioner (primary health care) records between birth and brain tumor diagnosis and for the first time, compares rates of attendance and reasons for consultation with those of unaffected children. RESULTS:On average, cases consulted more often than controls between birth and diagnosis/pseudodiagnosis with brain tumor signs and symptoms. Their consultation rate with Ն1 suggestive symptom escalated in the 2 years before diagnosis. Symptom prevalence was higher among cases than controls, a relative difference of 3.29 times as many consultations with Ն1 suggestive symptom (95% confidence interval [CI]: 2.82-3.83) and 7.01 as many with more than 1 (95% CI: 5.38 -9.13). In each 6-month period in the 4 years before diagnosis, cases had at least twice as many consultations with Ն1 suggestive symptom (20.81 times as many in the 6 months before diagnosis ) and 2-3 times more records of suggestive symptoms (28.35 times more in the 6 months before diagnosis ). Symptoms rarely or not observed among control children included head tilt, odd head movements, odd posture, back or neck stiffness, and unsteadiness without obvious cause.CONCLUSION Key to identifying the 1 child among many who merits prompt investigation is recognition of unusual symptoms, or specific symptom patterns.

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Section: Discussionmentioning

confidence: 67%

Section: Discussionmentioning

confidence: 99%

Section: Datamentioning

confidence: 99%

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confidence: 99%

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Brain Tumor Signs and Symptoms: Analysis of Primary Health Care Records From the UKCCS

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“…Accordingly, only the length of the prediagnostic symptomatic interval (PSI) can provide some indirect evidence regarding the kinetics of tumour growth: Not only are differences documented between different types of brain tumours, with malignant tumours (e.g. MBs) having shorter PSIs than low-grade tumours [4,10,12,17,19], but considerable variability is seen within the patient group with MB [2,8]: In a large prospective series, we found PSIs ranging from 0 to 24 months, with a median of 2 months. Interestingly, the group of patients with the longest PSIs had lower stage disease at diagnosis and a better overall survival probability than that with shorter PSIs [6].…”

Section: Discussionmentioning

confidence: 99%

Natural history of a medulloblastoma: 30 months of wait and see in a child with a cerebellar incidentaloma

et al. 2013

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INTRODUCTION:With the increasing use of neuroimaging studies, the discovery of incidental neoplastic lesions is becoming more frequent. However, standard procedures are lacking, and little is known about their optimal management. CASE REPORT: We here present the case of a boy with a cerebellar mass incidentally discovered on a CT scan performed after head trauma. In another scan performed after another incident of head trauma 14 months earlier, the lesion could be seen after retrospective examination. In view of the asymptomatic clinical and stable radiological status and the presumed diagnosis of a low-grade glioma, a watch-and-wait strategy was elected. After clinical and radiological progression was observed, the tumour was resected, 2½ years after the initial imaging study. Histological evaluation revealed a WNT pathway-activated classical medulloblastoma. DISCUSSION: To our knowledge, this is the first description of such a long natural history and pre-symptomatic period of a medulloblastoma. The long period of stability followed by a period of accelerated tumour growth is compatible with increasing biological aggressiveness, possibly related to the stepwise accumulation of genetic changes. DOI: https://doi.org/10.1007/s00381-013-2077-9Posted at the Zurich Open Repository and Archive, University of Zurich ZORA URL: https://doi.org/10.5167/uzh-81611 Accepted Version Originally published at: Zeilhofer, Ulrike B; Scheer, Ianina; Warmuth-Metz, Monika; Rushing, Elisabeth J; Pietsch, Torsten; Boltshauser, Eugen; Grotzer, Michael A; Gerber, Nicolas U (2013). Natural history of a medulloblastoma: 30 months of wait and see in a child with a cerebellar incidentaloma. Child's Nervous System, 29 (7) ABSTRACTWith the increasing use of neuroimaging studies, the discovery of incidental neoplastic lesions is becoming more frequent. However, standard procedures are lacking and little is known about their optimal management. We here present the case of a boy with a cerebellar mass incidentally discovered on a CT scan performed after head trauma. In another scan performed after another incident of head trauma 4 months earlier, the lesion could be seen after retrospective examination. In view of the asymptomatic clinical and stable radiological status and the presumed diagnosis of a low-grade glioma, a watch-and-wait strategy was elected. After clinical and radiological progression was observed, the tumour was resected, 2½ years after the initial imaging study. Histological evaluation revealed a WNT pathway-activated classical medulloblastoma. To our knowledge, this is the first description of such a long natural history and pre-symptomatic period of a medulloblastoma. The long period of stability followed by a period of accelerated tumour growth is compatible with increasing biological aggressiveness, possibly related to the stepwise accumulation of genetic changes.

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Referral for Ophthalmology Evaluation and Visual Sequelae in Children With Primary Brain Tumors

et al. 2019

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Key Points Question In children with brain tumors, what is the referral rate to ophthalmology and what is the prevalence of visual sequelae and their association with tumor characteristics? Findings In this cohort study of 141 children with primary brain tumors, only 68 (48%) were referred for comprehensive eye examination. While only 15% of those referred had visual symptoms, more than 90% had a variety of visual impairments including both afferent and efferent diseases, with visual field defects being the most common impairment among patients without symptoms. Meaning Ophthalmologic evaluation is recommended for early diagnosis of visual sequelae in children with brain tumors to prevent permanent vision loss.

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Presentation of childhood CNS tumours: a systematic review and meta-analysis

Cited by 333 publications

References 77 publications

Brain Tumor Signs and Symptoms: Analysis of Primary Health Care Records From the UKCCS

Brain Tumor Signs and Symptoms: Analysis of Primary Health Care Records From the UKCCS

Natural history of a medulloblastoma: 30 months of wait and see in a child with a cerebellar incidentaloma

Referral for Ophthalmology Evaluation and Visual Sequelae in Children With Primary Brain Tumors

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