1. Hauser Péter

2. Anamnesis 1. 5-year old, female II/2 normal pregnancy, pvn, 3200g previous anamnesis: upper airway infections 3 months before: –diarrhoea, vomiting –no apetite, headche, abdominal pain –no fever

3. Anamnesis 2. last 3 months: –daily headache –daily retches –vomitus every 2-3 days –appointment to gastroenterologist some days later: –increasing headache

4. Headche dd commonrare upper airway infections fever viral infection sinusitis, otitis dental problem visual disturbances dehydration trauma sunstroke starvation hypotension psychological imitation hypertension migraine meningitis encephalitis CNS bleeding CNS tumors

5. Symptoms of increased ICP Headache Nausea vomiting (especially morning) stiffneck papilledema bulging fontanelle, increasing head circumference (<1,5yrs) (Bradypnoe) (Bradycardia)

6. Causes of increased ICP Mass effect (CNS bleeding, tumor) Oedema (meningitis, encephalitis, hypoxia,vasculitis, metabolic disturbances) CSF-flow blockade (hydrocephalus, VP-shunt blockade)

7. When to think about brain tumor? Headche + Neurological sign or symptom and/or Symptoms of increased ICP (symptoms are usually not specific to tumor !!!)

8. Neurological signs (localization dependent) Infratentorial: ICP  + ataxia, coordnation disturbances Supratentorial: ICP  + blurred vision localization dependent signs, epilepsy, behavioral changes Brainstem: cerebral nerve palsy ataxia hemiparesis Hormonal disturbances (corpus pineale, hypophysis)

9. Diagnosis essential: THINK OF IT ! thorough neurological examination MRI (brain+spine) Opus – histology CSF sampling

11. Histology based on localization Supratentorial: astrocytoma (A1-4) (50%)PNET ependymoma Infratentorial: astrocytoma (A1-2) (35%)medulloblastoma ependymoma (E1-3) Brainstem: (15%)astrocytoma (A1-4) Pineal region : germ cell tumors PNET

12. Chemosensitivity Medulloblastoma Germ cell tumors AT/RT PNET Astrocytoma G1 Glioblastoma multiforme Plexus choroideus cc

13. Therapy planning Surgery Chemotherapyirradiation Histology High dose chemotherapy with stem cell rescue (ABMT) Molecular th Age Extent of resection Molecular profile