Symptoms of Brain Lesions in Children
Children with brain lesions most commonly present with signs of raised intracranial pressure (headache, nausea, vomiting), seizures, or focal neurological deficits, though many lesions are discovered incidentally and remain asymptomatic. 1
Primary Symptom Categories
Signs of Raised Intracranial Pressure
- Headache is one of the most common presenting symptoms, particularly severe or worsening headaches 2, 3
- Nausea and vomiting occur frequently and may be misdiagnosed as gastroenteritis 1
- Papilledema on ophthalmologic examination indicates elevated intracranial pressure and warrants immediate neuroimaging 1
- In infants, manifestations include inconsolable crying and bulging fontanelle 4
Seizure Activity
- New-onset unprovoked seizures are a common presenting symptom of brain lesions 1, 5
- Multiple seizures at presentation are significantly associated with epileptogenic lesions (p < 0.001) 5
- Prolonged seizures lasting ≥5 minutes increase the likelihood of an underlying structural brain lesion 5
Focal Neurological Deficits
- Balance problems or difficulty with motor activities may indicate cerebellar or brainstem involvement 4
- Visual changes can occur with lesions affecting visual pathways 2
- Altered mental status or confusion suggests more serious brain injury 2
Cognitive and Behavioral Changes
- Difficulty concentrating on schoolwork or daily activities 2
- Fatigue that interferes with normal functioning 2
- Emotional lability or personality changes 2
- Developmental delay is significantly associated with epileptogenic lesions (p < 0.001) 5
Location-Specific Symptoms
Posterior Fossa/Cerebellar Lesions
- Lesions in the cerebellum or posterior fossa are more likely to require surgical intervention (90% vs 27% for supratentorial lesions, p = 0.006) 6
- These locations more commonly produce symptoms due to proximity to critical structures and risk of obstructive hydrocephalus 6
Midline and Brainstem Lesions
- Lesions in midline structures or brainstem often require earlier intervention due to location rather than size 6
Critical Warning Signs Requiring Emergency Evaluation
The following symptoms indicate potentially life-threatening complications and necessitate immediate medical attention:
- Loss of consciousness 2
- Severe or worsening headache despite treatment 2
- Repeated vomiting 2
- Seizures 2
- Clear or bloody fluid draining from nose or ears 4
- Swelling or deformities of the scalp 2
Important Clinical Pitfalls
A critical diagnostic error occurs when children presenting with nausea, vomiting, and headaches are misdiagnosed with "gastroenteritis" or "viral upper respiratory tract infection" without proper neurological examination. 1 This delay in diagnosis can cause serious negative outcomes and is avoidable through:
- Thorough neurological examination at first presentation 1
- Screening for papilledema in any child with persistent headache, nausea, and vomiting 1
- Maintaining high clinical suspicion for CNS neoplasms, which are not uncommon in children 1
Asymptomatic Incidental Findings
Importantly, many brain lesions in children are discovered incidentally during imaging for unrelated problems and remain asymptomatic. 6, 7
- Incidental brain lesions occur in 0.2-5.7% of children undergoing neuroimaging 8
- Most incidental lesions (77.8%) show no progression over time 7
- When progression occurs, mean time to progression is 32.3 months 7
- Overall survival for incidentally detected lesions is 100% at median follow-up of 32 months 6