The Presenting Feature and Role of General Practitioners and Non-neurosurgeon Physicians in Recognizing Pediatric Brain Tumors

AIM: To determine the presenting features and role of non-neurosurgeon physician in recognizing the signs and symptoms of brain tumours in children. METHOD: Medical records of 31 pediatric brain tumor patients treated in Department of Neurosurgery, Soetomo General Hospital, Airlangga University Faculty of Medicine, Surabaya from August 2005 to September 2006 were reviewed. RESULTS: Thirty five percents f parents went to pediatrician as their first contact physician, 25% to general practitioner, 20% neurologist, 20% to neurosurgeon. Neurosurgeon was the second and third contact physician receiving refferal from non-neurosurgeon physician. The most common symptoms were headache (71%), vomiting (61%), motor weakness (48%), visual disturbance (45%), decrease level of consciousness (45%) and seizures (38%), unsteadiness (35%). The most common symptoms that led the parents to find medical help at any time were motor disturbance (48%), vomiting (48%), visual disturbance (45%), unsteadiness (35%), decrease level of consciousness (32%), seizures (32%), headache (32%). All patients had neurological signs at diagnosis; 58% had papilloedema, 48% cranial nerve abnormalities, 35% cerebellar signs, 32% motor disturbance, 29% a reduced level of consciousness, 12% cranial enlargement. Duration of symptoms at admission was 1 months (32%), 2 months (42%), 3-6 months (19%), more than 6 months (7%). A short symptom interval was significantly associated with high grade tumours and patient age 3 years or younger. CONCLUSION: The symptoms and signs are often nonspecific, mimicking more common diseases. Therefore, the possibility of a brain neoplasm should always be considered, it materializes very rarely. Benign neurologic symptoms such as headache, which last for 2 months or more, should indicate the need of additional studies. Our results higlighted the neurologic impairments which might facilitate early recognition of a brain neoplasm. Neurologic problems as the only symptom of brain tumor may mislead pediatricians and neuropediatricians, so that a low index of suspicion may delay the diagnosis. [TAF Prev Med Bull 2010; 9(2): 133-138]