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A symptomatic journey to the centre of the brain
  1. Daniel P Hawley1,
  2. David A Walker2
  1. 1Division of Child Health, University Hospital Queen's Medical Centre, Nottingham, UK
  2. 2Division of Child Health, The University of Nottingham, Nottingham, UK
  1. Correspondence to Dr Daniel P Hawley, Division of Child Health, University Hospital Queen's Medical Centre, Nottingham NG7 2UH, UK; dhawley{at}

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We write this article as paediatric central nervous system (CNS) neoplasms are a heterogeneous group of conditions, reflecting the interaction between varying tumour types with varying individual susceptibility. Presentation is dependent on these variables.

A quarter of childhood cancers arise in the CNS and account for the largest number of cancer deaths in childhood.1 Despite this, CNS neoplasms are generally considered rare in children. Difficulty achieving early diagnosis is further compounded by the non-specific nature of initial symptoms, which also occur in commoner and less serious conditions such as migraine and gastroenteritis. Timely diagnosis therefore remains challenging.2


We hope to increase knowledge of presenting symptoms and strengthen understanding of how anatomy correlates with symptoms. By improving understanding of the impact a timely diagnosis has on prognosis, we hope to raise awareness of these diseases and the appropriate investigative tests. We hope the following cases will be both illustrative and instructive.

Case 1 (see timeline 1)

Timeline 1

James, an 11-year-old boy, initially presented to his general practitioner (GP) with a 3-week history of headaches. Simple analgesia was advised and reassurance given. The headaches worsened but were not related to any time of day or night. Two weeks later further reassurance was given during a repeat GP consultation. At a third consultation 4 weeks later, the GP appropriately considered the possibility of short- or long-sightedness as a potential cause for childhood headache, and advised that an eye check-up should be arranged. Unfortunately, no further history was sought nor examination performed at this time. The family delayed by one further week before arranging an eye examination, at which the community optometrist was concerned by loss of upgaze and referred James to the local hospital for urgent review (timeline 1). In hospital three important areas were addressed by the admitting paediatric registrar:

  • Further history was obtained:

    • blurred vision …

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  • Competing interests None.

  • Provenance and peer review Commissioned; externally peer reviewed.