Selected aspects of pre-clinical diagnosis of posterior cranial fossa tumours in children at paediatric departments of district hospitals in Lesser Poland and Podkarpacie

Lesław Ciepiela
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Stanisław Kwiatkowski
Department of Neurology & Outpatient Clinc of Childneurologii Health Care Centre in Debica, Debica, Poland
Z Oddziału Neurochirurgii, Uniwersytecki Szpital Dziecięcy Kraków

Abstract

Enormous progress has been made in a diagnosis of central nervous system (CNS) tumours in the past dozen or so years. Computed tomography (CT) and magnetic resonance (MR) made that progress possible. Those methods facilitate an early and accurate diagnosis of most of CNS tumours. Yet modern imaging methods cannot replace a detailed subjective assessment of a patient’s medical history and a neurological examination. The knowledge of the symptoms and the circumstances in which they occur makes a precise diagnosis possible. Data showed that only 24 percent of paediatricians moved the diagnostic process in the right direction after their first contact with a patient. Delays in diagnosing a brain tumour usually mean a more extensive surgery, often without the possibility of complete removal of tumour tissue, and postoperative complications. The aim of this study was the examination of the diagnostic process of posterior cranial fossa tumour in children from primary care through department of paediatrics to department of neurosurgery. The study focused on the correlation between the demographic and educational factors and between the accuracy and promptness of a diagnostic decision. It checked oncological vigilance of doctors. Major difficulties in CNS tumour diagnosis are: 1. Low incidence of such cases in paediatric practice. 2. Absence of oncological vigilance. 3. Misinterpretation of symptoms such as morning headaches and vomiting. 4. Exclusion of rare symptoms such as neck pain, little educational progress, emotional changes. Imaging methods (CT and MR) are widely available and have no influence on the CNS tumours diagnosis.

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