Pediatric emergency medicine trisk 1149 1149
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child with headaches must always be carefully assessed. A diminished level of
consciousness may be the result of encephalitis, a large intracranial hemorrhage,
or significantly elevated ICP. To the extent that the child can cooperate, cranial
nerve function should also be evaluated. Cranial nerve abnormalities may result
from an elevated ICP or direct compression by a mass lesion. Sensory and motor
function should be examined, although here again the ability of a younger patient
to cooperate may be limited. A reasonable evaluation can be accomplished by
observing the child’s gait while walking and/or running and by assessing the
child’s dexterity in performing age-appropriate activities, such as transferring a
toy from hand to hand and tying shoelaces. Any evidence of abnormalities in gait
or fine motor coordination warrants further investigation.
TABLE 59.5
FREQUENCY OF PRESENTING SIGNS AND SYMPTOMS IN
CHILDREN WITH BRAIN TUMORS
Headache (33%)
Nausea and vomiting (32%)
Abnormal gait or coordination (27%)
Papilledema (13%)
Seizures (13%)
Squint (7%)
Change in behavior or school performance (7%)
Cranial nerve palsies (7%)
Reprinted from Wilne S, Collier J, Kennedy C, et al. Presentation of childhood CNS tumours: a systematic
review and meta-analysis. Lancet Oncol 2007;8:685–695. Copyright © 2007 Elsevier. With permission.
