Central nervous system tumor (peds): Difference between revisions
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{{Peds top}} [[Central nervous system tumor]].'' | |||
==Background== | ==Background== | ||
*2nd most common pediatric cancer (20%) | *2nd most common pediatric cancer (20%) | ||
==Clinical Features== | ==Clinical Features== | ||
*Depends on location | *Depends on location | ||
**Posterior Fossa | **Posterior Fossa | ||
***Headache | ***[[Headache]] | ||
****Early morning (sleep > hypoventilation > hypercarbia > | ****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 | ||
*** | ***Effortless [[vomiting]] | ||
***[[Cranial nerve palsies]] (especially 6th nerve) | |||
**Brainstem | **Brainstem | ||
*** | ***[[Cranial nerve palsies]] (facial weakness, abducens palsy, dysphagia), ataxia | ||
**Supratentorial | **Supratentorial | ||
*** | ***[[Headache]], personality change, motor [[weakness]], [[seizure]] | ||
**Sellar | **Sellar | ||
***Visual changes, hypothalamic dysfunction ( | ***[[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== | ==Differential Diagnosis== | ||
{{Pediatric HA DDX}} | |||
== | ==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]] | *[[Head CT]] | ||
== | ==Management== | ||
*[[Increased ICP]] | *[[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 | ***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== | ==See Also== | ||
*[[Herniation Syndromes]] | *[[Herniation Syndromes]] | ||
*[[Elevated ICP]] | |||
*[[Cerebral edema in brain cancer]] | |||
==References== | ==References== | ||
<references/> | |||
[[Category:Heme/Onc]] | [[Category:Heme/Onc]] | ||
[[Category: | [[Category:Neurology]] | ||
[[Category: | [[Category:Pediatrics]] | ||
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)
- Headache
- Brainstem
- Cranial nerve palsies (facial weakness, abducens palsy, dysphagia), ataxia
- Supratentorial
- Sellar
- Visual changes, hypothalamic dysfunction (diabetes insipidus, stunted growth, hypothyroidism)
- Posterior Fossa
- 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
- Headache (from increased pressure on heavily innervated meninges)
- Seizure
- Altered mental status, irritability, coma
Differential Diagnosis
Pediatric Headache
- Primary headache
- Secondary headache
Evaluation
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)