The pre-diagnostic period of 252 children (median age 6.3 years, range 0-16.9 years) with primary brain tumours was assessed to analyse their clinical presentation and reasons for any delay in diagnosis. The median pre-diagnostic symptomatic interval (PSI) was 60 days (range 0-3010 days) with a parental delay of 14 days (range 0-2310 days) and a doctor's delay of 30 days (range 0-3010 days). Only 33% of brain tumours were diagnosed within the 1st month after the onset of signs/symptoms. PSI correlated significantly with patients' age and tumour histology, but not with gender, year of diagnosis or tumour location (supratentorial hemispheric, supratentorial midline, infratentorial). In children older than 2 years, most common initial signs/symptoms were headache, nausea/vomiting, seizures, squint/diplopia, ataxia and behavioural changes. In children younger than 2 years, most common initial signs/symptoms were seizures, vomiting, head tilt and behavioural changes. These signs/symptoms are by no means pathognomonic features of brain tumours, making the diagnosis in the early course often difficult.
Conclusion: given the fact that the vast majority of patients (88% in the present study) develop further signs/symptoms, a high level of awareness, a detailed medical history and repeated correctly interpreted neurological examinations should lead to an earlier diagnosis and to a higher probability of total tumour resection.