Brain Lesion in Children

Aka: Brain Lesion in Children, Brain Tumor in Children, Pediatric Brain Tumor, Intracranial Mass in Children

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II. Epidemiology

  1. Most common childhood solid neoplasm (15-20% of all pediatric malignancies)
    1. Second only to Leukemia for overall cancer Incidence
  2. Age
    1. Peak Incidence: age 3 to 12 years old
    2. Infants and young children: Embryonal origin tumors (e.g. Medulloblastoma)
    3. Age >10 years: Glioblastoma

III. Risk Factors

  1. Cranial exposure to radiation
    1. Meningiomas
    2. Astrocytomas
    3. Glioblastoma multiforme
  2. Genetic Factors
    1. Family History in 19% of cases overall
    2. Family History in 30% of Glioblastoma Multiforme
  3. Associated conditions
    1. Neurofibromatosis
    2. Tuberous sclerosis
    3. Turcot Syndrome
    4. Li-Fraumeni cancer syndrome
    5. Von Hippel Lindau

IV. Causes: Tumor types (under age 20 years)

  1. Supratentorial (40%)
    1. Astrocytoma (8-12%)
    2. Glioblastoma (<5%)
    3. Craniopharyngioma (5-8%)
    4. Ependymoma (3-5%)
    5. Choroid Plexus papilloma (2-3%)
    6. Pituitary tumor (<1%)
    7. Pineal tumor (2%)
    8. Meningioma (<1%)
  2. Infratentorial (60%)
    1. Medulloblastoma (18-25%)
    2. Cerebellar Astrocytoma (15-20%)
    3. Brain Stem glioma (8-10%)
    4. Ependymoma (4-6%)
    5. Schwannoma (<1%)
    6. Meningioma (<1%)

V. Findings

  1. Infants
    1. Failure to Thrive
    2. Irritability
  2. Older children
    1. CSF Outflow obstruction with Hydrocephalus and Increased Intracranial Pressure
    2. Common presentations
      1. Progressive Headaches
      2. Nausea and Vomiting (esp. in the morning)
      3. Balance or gait problems
    3. Other presentations
      1. Focal neurologic deficits (e.g. Cranial Nerve palsy)
      2. Altered Mental Status
      3. First-time Seizure (13% of pediatric CNS tumor presentations)

VI. Imaging

  1. MRI Brain
    1. Preferred imaging, with best diagnostic images and no-ionizing radiation
    2. However, limited availability and typically requires sedation in younger children
  2. CT Head
    1. Consider in urgent and emergent settings for acute presentations

VII. Management: Emergency Department

  1. Seizures
    1. See Seizure Management
  2. Intracranial Hypertension or impending Brainstem Herniation
    1. See Cerebral Herniation
    2. May present with cushing triad (Hypertension, Bradycardia, irregular respiration pattern)
    3. Corticosteroids (e.g. Dexamethasone)
    4. Osmotic agents (Hypertonic Saline or Mannitol)
    5. Neurosurgery Consultation
  3. ABC Management
    1. Supportive care to maintain normotension and normal carbon dioxide
  4. Consultation and Referral
    1. CNS tumor evaluation and management (neurosurgery, oncology)

VIII. References

  1. Collyer, Huang and Seo (2026) Crit Dec Emerg Med 40(1): 26-33

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