headsmartjordan

Balance/walking/

co-ordination

Reassure

Motor abnormality with obvious local cause e.g. injury, inflammation or infection
No associated symptoms or signs
No risk factors for a brain tumour
No other abnormalities detected on examination

Action

Reassure

Review/refer

Motor abnormality present for less than two weeks
No obvious local cause
No high risk conditions
No associated symptoms or signs

Action

Observe and review two weeks after symptom onset

Scan

New onset motor abnormality that may occur with a brain tumour:

Ataxic gait
Abnormal coordination
Focal motor weakness (e.g. hemiplegia/hemiparesis/altered hand preference)
Head tilt
Persistent motor regression/loss of motor skills
Persistent swallowing difficulties without local cause
New onset facial weakness that shows no improvement within four weeks
Other neurological or endocrinological symptoms or signs, including poor growth

Action

Scan - motor abnormality with one or more other symptoms

Diagnostic pitfalls

• Attributing an unsteady walk (ataxic gait) to an ear infection without corroborative ear findings
• Not considering swallowing difficulties and recurrent aspiration as a cause of "chestiness" in children.

Examination/assessment

•Assess motor skills including:

• Sitting/crawling in infants.

• Walking/running in older children

• Co-ordination e.g. heel-toe walking, finger-nose testing

• Fine motor skills, e.g. handling of a small toy / cup in young children.

• Handwriting in school age children and young people

• Touching tip of thumb with tip of each finger of the same hand in turn in school age children and young people

• Ask specifically about associated symptoms and risk factors:

• Personal or family history of a brain tumour

• Leukaemia

• Sarcoma and early onset breast or bowel cancer prior therapeutic CNS irritation

• Neurofibromatosis types 1 and 2

• Tuberous Sclerosis

• Li Fraumeni Syndrome

• Family history of colorectal polyposis

• Gorlins Syndrome

• Other familial genetic syndromes

• Neurological examination (include assessment of vision (including acuity), gait and coordination)

• Plot growth in all children and pubertal status if applicable

• Plot head circumference in children under two years old

Balance/walking/

co-ordination

Reassure

Action

Review/refer

Action

Scan

Action

Diagnostic pitfalls

• Attributing an unsteady walk (ataxic gait) to an ear infection without corroborative ear findings

• Not considering swallowing difficulties and recurrent aspiration as a cause of "chestiness" in children.

Examination/assessment

•Assess motor skills including:

• Sitting/crawling in infants.

• Walking/running in older children

• Co-ordination e.g. heel-toe walking, finger-nose testing

• Fine motor skills, e.g. handling of a small toy / cup in young children.

• Handwriting in school age children and young people

• Touching tip of thumb with tip of each finger of the same hand in turn in school age children and young people

• Ask specifically about associated symptoms and risk factors:

• Personal or family history of a brain tumour

• Leukaemia

• Sarcoma and early onset breast or bowel cancer prior therapeutic CNS irritation

• Neurofibromatosis types 1 and 2

• Tuberous Sclerosis

• Li Fraumeni Syndrome

• Family history of colorectal polyposis

• Gorlins Syndrome

• Other familial genetic syndromes

• Neurological examination (include assessment of vision (including acuity), gait and coordination)

• Plot growth in all children and pubertal status if applicable

• Plot head circumference in children under two years old

Persistent/recurrent headache

Balance/co-ordination/walking problems

Persistent/recurrent vomiting

Abnormal eye movements

Blurred or double vision/loss of vision

Behaviour change

Fits or seizures

Abnormal head position such as wry neck, head tilt or stiff neck

Delayed puberty

Increasing head circumference

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