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Raised intracranial pressure from brain tumour — RACP Paediatrics MCQ

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HardNeurology and neurodevelopmentRaised intracranial pressure from brain tumourRACP Paediatrics

A 10-year-old has three weeks of morning headache, early-morning vomiting and declining school performance. Examination shows papilloedema and a left sixth nerve palsy. What is the most appropriate investigation?

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Correct answer: E — Urgent MRI brain with neurosurgical consultation

Morning headache, vomiting, papilloedema and sixth nerve palsy indicate raised intracranial pressure, requiring urgent neuroimaging before any lumbar puncture. LP before imaging risks herniation if a mass lesion is present. The pearl is that cranial nerve VI palsy can be a false-localising sign of raised intracranial pressure.

Reference: RCH Clinical Practice Guidelines: Headache; Therapeutic Guidelines (eTG)