Central nervous system tumor (peds): Difference between revisions

Latest revision as of 22:16, 11 November 2020

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
  - Headache, personality change, motor weakness, seizure
- Sellar
  - Visual changes, hypothalamic dysfunction (diabetes insipidus, stunted growth, hypothyroidism)
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

Primary headache
- Migraine
- Tension
- Cluster
Secondary headache
- Viral illness and fever
- Post-traumatic
- VP shunt malfunction
- CO poisoning
- Epidural hematoma
- Subdural hematoma
- Brain abscess
- Pseudotumor cerebri
- Meningitis
- Space-occupying lesion
- AVM
- Sinusitis
- Dental abscess
- Otitis media
- CNS tumor

Evaluation

Giant parietal lobe infantile gliosarcoma in a 5-year-old child.

Pediatric choroid plexus carcinoma.

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)

References

Authors:

@@ Line 1: / Line 1: @@
+{{Peds top}} [[Central nervous system tumor]].''
 ==Background==
 *2nd most common pediatric cancer (20%)
-==Diagnosis==
+==Clinical Features==
 *Depends on location
 **Posterior Fossa
-***Headache
+***[[Headache]]
-****Early morning (sleep > hypoventilation > hypercarbia > incr CNS bloodflow > incr ICP)
+****Early morning (sleep > hypoventilation > hypercarbia > increases CNS blood flow > increased ICP)
-***Effortless vomiting
+****Red flags also include headaches that are worse with valsalva, wakes from sleep, occur daily
-***CN palsies (esp 6th nerve)
+***Effortless [[vomiting]]
+***[[Cranial nerve palsies]] (especially 6th nerve)
 **Brainstem
-***CN deficits (facial weakness, abducens palsy, dysphagia), ataxia
+***[[Cranial nerve palsies]] (facial weakness, abducens palsy, dysphagia), ataxia
 **Supratentorial
-***
+***[[Headache]], personality change, motor [[weakness]], [[seizure]]
+**Sellar
+***[[Visual disturbances|Visual changes]], hypothalamic dysfunction ([[diabetes insipidus]], stunted growth, [[hypothyroidism]])
+*[[Increased ICP]] features
+*Features of [[elevated ICP]] (from [[Cerebral edema in brain cancer|cerebral edema]], [[Intracranial hemorrhage|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 HA DDX}}
-==Work-Up==
+==Evaluation==
+[[File:PMC4489064 JPN-10-159-g001.png|thumb|Giant parietal lobe infantile gliosarcoma in a 5-year-old child.]]
+[[File:PMC3560637 medscimonit-18-5-CS37-g001.png|thumb|Pediatric choroid plexus carcinoma.]]
+*[[Head CT]]
+==Management==
-==DDx==
+*[[Increased ICP]]
+**[[Benzodiazepines]] +/- [[AEDs]] if actively seizing
+**[[Dexamethasone]](reduce tumor capillary permeability, inflammatory cytotoxicity)- 1mg/yr of age (max 10mg)
-==Treatment==
+***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)
-==Disposition==
+**Consider osmotherapy (e.g. [[hypertonic saline]], [[mannitol]])
 ==See Also==
+*[[Herniation Syndromes]]
+*[[Elevated ICP]]
+*[[Cerebral edema in brain cancer]]
-==Source==
+==References==
+<references/>
-[[Category:Peds]]
 [[Category:Heme/Onc]]
+[[Category:Neurology]]
+[[Category:Pediatrics]]