I have diagnosed many brain tumors within the past 5 years. Given my practice environment in the pediatric ED, we often are the ones to make this diagnosis – based mostly on history, clinical suspicion, and physical examination. Imaging typically confirms what we fear and suspect if we feel a scan is clinically warranted. A child with early am headaches, especially if accompanied by emesis, change in gait, speech, personality, school performance, visual changes, or new onset afebrile seizure, can all be indications of a potential brain tumor. At the point of suspicion a CT will be ordered, typically without contrast. However, if there is a concern for cerebellar lesions, an MRI often needs to be done. An MRI is often better for fine details of the brain, grading tumors, and is helpful for neurosurgery’s development of their management plan. Often, physical findings like head tilt, papilledema, facial droop, and cerebellar signs may be present – though not always. Vital signs are also important – especially pulse and blood pressure – as increased intracranial pressure may be manifested as bradycardia, altered respiratory pattern and hypertension. If symptoms are acute, doctors must consider cva, atypical migraine, seizure, infectious causes like an abscess or meningitis, in addition to a potential tumor or mass.
