Presenting symptoms of pediatric brain tumors diagnosed in the emergency department

Abstract

Objective: The primary objective of this study is to categorize the symptoms associated with brain tumors as diagnosed in the emergency department (ED). The secondary objective is to detail the specific characteristics of these headaches via a subgroup analysis.

Methods: A retrospective chart review was performed among patients younger than 18 years presenting to a large urban tertiary care facility. Electronic medical records were searched and reviewed from 2002 to 2011 for inpatient discharge diagnoses using malignant and benign central nervous system tumor International Classification of Diseases, Ninth Revision codes.

Results: The electronic records of ED visits for 87 patients were reviewed. The most frequent signs and symptoms were as follows: headache (66.7%), hydrocephalus (58.6%), nausea/vomiting (49.4%), gait disturbance (42.5%), vision changes (20.7%), seizure (17.2%), behavior/school change (17.2%), cranial nerve deficits (16.1%), altered mental status (16.1%), back/neck pain (16.1%), papilledema (12.6%), facial asymmetry (10.3%), sensory deficits (8.0%), focal motor weakness (6.9%), cranial nerve 6 deficit (6.9%), ptosis (5.7%), macrocephaly (4.6%), asymptomatic (3.4%), and anisocoria (1.1%). The frequencies of location of headache were diffuse (24.1%), frontal (12.1%), occipital (8.6%), and parietal/temporal (6.9%). The severity was described as severe (37.9%) followed by moderate and mild (10.3% and 5.2%, respectively). Most headaches occurred in the morning (13.8%) and night (12.1%), and their quality was predominantly progressively worsening (50.0%)

Conclusions: Brain tumors diagnosed in the ED most commonly present with headache, hydrocephalus, nausea/vomiting, and gate disturbances. The headaches are described as progressively worsening and diffuse most commonly occurring in the morning and night.