Pediatric emergency medicine trisk 1150 1150

TABLE 59.6 FREQUENCY OF PRESENTING SIGNS AND SYMPTOMS IN CHILDREN UNDER YEARS OF AGE WITH BRAIN TUMORS Macrocephaly (41%) Nausea and vomiting (30%) Irritability (24%) Lethargy (21%) Abnormal gait and coordination (19%) Weight loss (14%) Bulging fontanelle (13%) Seizures (10%) 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 Laboratory and Radiographic Testing Most children presenting in an acute-care setting with headache as the chief complaint will not require any laboratory tests The child with a possible serious infectious process causing headaches can require a variety of tests, including a complete blood cell count, lactic acid, blood cultures, and a lumbar puncture Yet these patients are more likely to have other symptoms such as high fever and lethargy, rather than headache, as the primary complaint When a lumbar puncture is necessary, it is important to remember that a head CT scan should be obtained first if the patient is suspected of having a lesion that could lead to subsequent cerebral herniation (e.g., a large intracranial mass or obstructive hydrocephalus) Signs suggestive of such a condition include focal neurologic deficits, focal seizures, papilledema, and mental status depression with unilateral pupillary dilation This is generally considered a prudent practice despite the fact that considerable controversy exists about whether herniation is ever actually caused by a lumbar puncture, even if temporally related For suspected idiopathic intracranial hypertension (i.e., a patient with papilledema who has a negative head CT), an opening pressure measurement should be obtained when the lumbar puncture is performed Serum electrolytes, blood urea nitrogen, creatinine, and a urinalysis should be obtained for any child with headaches who is found to have an elevated blood pressure The patient with a ventricular shunt who has fever and headaches will likely require a shunt tap by a neurosurgical consultant Finally, a child with a suspected subarachnoid hemorrhage should undergo a lumbar puncture if the head CT scan is negative This is necessary because a