Differential Diagnosis for a 6-year-old with Brain Tumor Signs

Single Most Likely Diagnosis

• Medulloblastoma: This is a common malignant brain tumor in children, often presenting with signs of increased intracranial pressure such as headache, nausea, vomiting, and ataxia. Its peak incidence is around the age of 5-7 years, making it a prime consideration for a 6-year-old.

Other Likely Diagnoses

• Pilocytic Astrocytoma: A type of glioma that is often benign and slow-growing, commonly found in children. It can cause a variety of symptoms depending on its location, including increased intracranial pressure, focal neurological deficits, and seizures.
• Ependymoma: A tumor that arises from the ependymal cells lining the ventricles and central canal of the spinal cord. It can cause symptoms by obstructing the flow of cerebrospinal fluid, leading to hydrocephalus and increased intracranial pressure.
• Germinoma: A type of germ cell tumor that is typically found in the pineal or suprasellar region. It can present with symptoms such as diabetes insipidus, visual disturbances, and increased intracranial pressure.

Do Not Miss Diagnoses

• Brain Abscess: Although less likely than tumors, a brain abscess can present with similar symptoms such as headache, fever, and focal neurological deficits. It is a medical emergency requiring prompt diagnosis and treatment.
• Central Nervous System Lymphoma: A rare but aggressive tumor that can mimic other brain tumors in its presentation. It requires early diagnosis and treatment to improve outcomes.
• Metastatic Disease: In children, metastatic disease to the brain from other primary sites (like leukemia) can present with symptoms similar to a primary brain tumor.

Rare Diagnoses

• Craniopharyngioma: A rare, usually benign tumor that arises near the pituitary gland. It can cause a variety of symptoms including endocrine disturbances, visual problems, and increased intracranial pressure.
• Choroid Plexus Papilloma: A rare, typically benign tumor of the choroid plexus that can cause hydrocephalus and increased intracranial pressure by obstructing cerebrospinal fluid pathways or producing excessive cerebrospinal fluid.
• Primitive Neuroectodermal Tumors (PNET): A group of highly malignant tumors that can occur in the brain, including medulloblastoma but also other rare entities like supratentorial PNET. They are aggressive and require prompt treatment.