Spinal Cord Tumors Tumors of the spinal cord are uncommon in children and account for a small fraction of all central nervous system tumors The most common spinal cord tumor is an astrocytoma Typically, spinal cord tumors cause pain at the tumor site and neurologic defects (e.g., sensory and motor defects, impaired bowel and bladder function), but symptoms may be slow to develop, often leading to delays in diagnosis Spinal cord tumors may also cause torticollis Patients with these tumors may also hold their heads in a forward flexed position (“hanging head sign”) An MRI of the spine should be obtained on any child with symptoms and signs suggestive of a spinal cord tumor, and emergency neurosurgical consultation should be obtained Vascular Anomalies Congenital berry aneurysms and acquired cerebral aneurysms may rupture spontaneously and result in life-threatening subarachnoid hemorrhages These can present with abrupt onset of severe headache, neck stiffness, nausea and vomiting, photophobia, and possibly fever, thus mimicking meningitis Other Space-Occupying Lesions of the Head and Neck Head and neck tumors are uncommon in children, and diagnosis requires a high index of suspicion Presenting signs and symptoms may include neck pain, stiffness, and/or torticollis Rhabdomyosarcomas, Ewing sarcomas, and lymphomas account for most of the tumors of the neck but other tumors occurring in this region include nasopharyngeal carcinomas, orbital tumors, acoustic neuromas, osteoblastomas, and metastatic tumors Arnold–Chiari malformation of the brain may also cause neck pain and stiffness Other Space-Occupying Lesions of the Spinal Cord Other uncommon spaceoccupying lesions of the cervical spine such as neurenteric cysts, arteriovenous malformations, spontaneous spinal epidural hematomas, and syringomyelia may also cause neck pain and stiffness, generally accompanied by neurologic findings Early diagnosis by MRI is essential Generally Non–Life-Threatening Causes Benign Tumors of the Head and Neck Osteoid osteoma is a benign bone tumor that commonly affects older children and adolescents Pain is the typical presenting symptom, often worse at night If the osteoma is in the cervical spine, neck pain and/or stiffness result Plain radiography is usually diagnostic, showing a well-demarcated radiolucent lesion surrounded by sclerotic bone Treatment