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Interval between onset of symptoms and diagnosis of medulloblastoma in children: distribution and determinants in a population-based study

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Abstract

Hospital-based studies have reported long delays in the diagnosis of paediatric brain tumours. Our objective was to describe the duration between onset of symptoms and diagnosis of medulloblastoma in children and study their clinical determinants in a population-based study. This retrospective cohort study included all paediatric medulloblastoma from a region of France from 1990 to 2005. The median interval from symptom onset until diagnosis for these 166 patients was 65 days and did not decrease during the study period. The most frequent manifestations were: vomiting (88%), headaches (79%), psychomotor regression (60% of children under 3 years), psychological symptoms (27%), strabismus (26%), and asthenia (25%). For one third of the children under 3 years, the diagnosis was made only after life-threatening signs of intracranial hypertension appeared. The prediagnosis interval was significantly longer (median 91 vs. 60 days, p = 0.001) in children with psychological symptoms (27%). Causes for intervals that exceeded the median (65 days) included inconsistent (25%) or late (36%) combination of headaches and vomiting, a period of spontaneous symptom remission (14%–20%), no (24%) or late (57%) neurological signs, psychological symptoms (35%), and a normal neurological examination (27%). Time to medulloblastoma diagnosis in children remains fairly long, despite advances in imaging. Primary-care physicians must be suspicious not only of suggestive neurological signs, but also of non-specific symptoms that persist or are multiple. A meticulous neurological examination and cerebral imaging for such patients might facilitate earlier diagnosis.

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Abbreviations

CT:

Computed tomography

MRI:

Magnetic resonance imaging

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Conflict of interest

The authors declare that they have no conflicts of interest.

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Authors and Affiliations

  1. Department of Paediatric and Adolescent Oncology, Institut Gustave Roussy, 39 rue Camille Desmoulins, 94805, Villejuif, France

    Jean-François Brasme, Dominique Valteau-Couanet & Jacques Grill

  2. Inserm U953, Epidemiological Research Unit on Perinatal Health and Women s and Children s Health, Hôpital Saint-Vincent-de-Paul, 82 avenue Denfert-Rochereau, 75014, Paris, France

    Jean-François Brasme & Martin Chalumeau

  3. Department of Paediatrics, Paris Descartes University; Hôpital Necker-Enfants Malades, AP-HP; 149 rue de Sèvres, 75 015, Paris, France

    Martin Chalumeau

  4. Department of Paediatric and Adolescent Oncology, Institut Curie, 26 rue d Ulm, 75005, Paris, France

    François Doz

  5. National Paediatric Cancer Registry, Department of Paediatric, and Adolescent Oncology, Hôpital d enfants, rue du Morvan, 54500, Vandoeuvre-lès-Nancy, France

    Brigitte Lacour

  6. Department of Neurosurgery, Hôpital Foch, 40 rue Worth, BP 36, 92151, Suresnes, France

    Stephan Gaillard

  7. Department of Paediatric Neurosurgery, Fondation Rothschild, 25 rue Manin, 75019, Paris, France

    Olivier Delalande

  8. Department of Neurosurgery, Centre Hospitalier de Bicêtre, AP-HP, 78, rue du Général Leclerc, 94276, Le Kremlin Bicetre, France

    Nozar Aghakhani

  9. Department of Paediatric Neurosurgery, Hôpital Necker-Enfants Malades, AP-HP, 149 rue de Sèvres, 75015, Paris, France

    Christian Sainte-Rose & Stéphanie Puget

Authors
  1. Jean-François Brasme
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  2. Martin Chalumeau
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  3. François Doz
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  4. Brigitte Lacour
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  6. Stephan Gaillard
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  7. Olivier Delalande
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  11. Jacques Grill
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Correspondence to Jean-François Brasme.

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Brasme, JF., Chalumeau, M., Doz, F. et al. Interval between onset of symptoms and diagnosis of medulloblastoma in children: distribution and determinants in a population-based study. Eur J Pediatr 171, 25–32 (2012). https://doi.org/10.1007/s00431-011-1480-z

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  • DOI: https://doi.org/10.1007/s00431-011-1480-z

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