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Brain Tumors in children

  1. Brain tumors are second only to leukemia as the most prevalent malignancy in childhood and they account for the most common solid tumors in this age group. Q
  2. Approximately 2/3 of all intracranial tumors occurring in children between the ages of 2 and 12 yr in infratentorial (located in the posterior fossa) In adolescents and infants younger than 2 yr tumors occur with equal frequencies in the posterior fossa and the supratentorial region
  3. Supratentorial tumor are more likely to be associated with focal abnormality including long tract sign and seizures
  4. Infratentorial tumors are present as sign /symptoms of intracranial tension.

Infratentorial tumors

  1. Cerebellar astrocytoma                        
  2. Medulloblastoma
  3. Brain stem glioma                
  4. Ependymomas             

Supra tentorial tumors

  1. Craniopharyngioma
  2. Optic nerve glioma
  3. Pinealoma
  4. Choroid plexus papilloma
    1. Cerebellar astrocytoma is the most common posterior fossa tumor of childhood and has the best prognosis
    2. Medulloblastoma is the next most common posterior fossa tumor in the pediatrics age group and is the most prevalent brain tumor in children younger than 7 year 
  5. Oligodendeoglioma

Cerebellar astrocytoma has no gender predilection

V. Meningitis


Acute Bacterial Meningitis


Bacterial meningitis may be defined as inflammatory response to bacterial infection of the pia arachnoid and the CSF of the subarachnoid space.



  1. Neonatal period gm –ve bacilli, Listeria monocytogenes groub B streptococci
  2. 2 month – 3-year Hemophilus influenzae, Strepto pneumoniae and Meningococci
  3. Beyond 3 year Pneumococci 


Complement deficiency C5 – C9 – meningococcalQ

Shunt infection – staphylococcal epidermidisQ


T cell defect (congenital Or acquired by chemotherapy, AIDS or malignancy Listeria monocytogenes Q 


  1. Hematogenous route
  2. Contigous septic foci in the skull or spine
  3. Head injury
  4. Recurrent meningitis
    1. Pilonidal sinus
    2. CSF rhinorrhoeaQ
    3. # of cribriform plateQ
    4. Immune deficiency disorder

Clinical features

  1. Onset is acute and febrile
  2. Irritable, has bursting headache
  3. Projectile vomiting, acute shrill cry, bulging fontanalle
  4. Photophobia
  5. Seizures
  6. Varying grades of alteration in sensorium may occur
  7. Sign of meningeal irritation present
    1. Neck rigidity
    2. Kernig’s sign
    3. Brudzinski’s sign
  • Neurological deficit like hemiparesis,cranial nerve palsies
  • Respiration may become periodic or Chynes strokes 

Meningitis in neonates and young infants


Sign and symptoms which arouse suspicion of bacterial meningitis in the new born are-

  1. Vacant stare
  2. Alternating irritability and drowsiness
  3. Refusal to suck
  4. Persistent vomiting
  5. Fever or Hypothermia
  6. Poor cry
  7. Neurological deficit of various type

Kernigs sign and neck rigidity are rarely present in early infancy


Specific features of meningitis due to different bacteria.

  1. Meningococcal meningitis
    Associated with petechial hemorrhages on the skin or mucosa. It is an acute fulminant condition sometimes associated with hypotension and shock. Q 
  2. Pneumococcal meningitis
    Usually follows otitis media, sinusitis, pneumonia or head trauma.
    Auditory complication and subdural effusions are common complication. 
  3. Staphylococcal meningitis
    Neonatal staphylococcal meningitis is often associated with umbilical sepsis, pyoderma or septicemia. 
  4. Hemophilus influenzae meningitis
    Frequent between 3 month – 3 year
    Subdural effusion follow the initial illness.
    Auditory deficit is a common complicationQ 

Lab diagnosis


Diagnosis should be confirmed by lumbar puncture and examination of the cerebrospinal fluid.



Cell count




50 – 80 mm Hg

< 5

20 – 45

> 50


Usually elevated

100 – 10, 000 PMNs cell predominants

100 – 500

< 40 (1/3 of blood glucose)


N /↑

100 – 1000 PMNs cell early but then lymphocytic predominance

50 – 200

Generally (N) may be ↓ in some viral disease particularly mumps


10 – 500 PMNs early but then lymphocytic


< 50 (1/3 – 2/3 of blood glucose)


Poor prognostic factor

  1. Infants younger than 6 months
  2. > 106 CFU of bacteria/mL of CSF
  3. Seizures occurring of > 4 daysQ
  4. Coma or focal neurological sign on presentation 


  1. Antibiotic treatment based of culture sensitivity
  2. Supportive treatment

Duration of treatment

  1. Strept. Pneumonae   10 – 14 days
  2. Meningococcal           5 –7 days
  3. H influenzae              7 – 10 days
  4. Gm –ve bacilli           21 days

Extra Edge

Corticosteroid therapy given to all children between 3 month – 3 year to incidence of auditory complication. Particularly due to H. influenza

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