Nystagmus in children with primary brain tumors in Denmark between 2007 and 2017

Abstract

Background The aim of the study was to evaluate the prevalence, clinical characteristics, and diagnostic importance of nystagmus in children with brain tumors. Methods A nation-wide retrospective review of all children diagnosed with a brain tumor between January the 1st, 2007 and December 31st, 2017, in Denmark. Data is based on information from the Danish Childhood Cancer Registry, hospital records from pediatric- and ophthalmological departments, and records from private ophthalmologists. Results Nystagmus was observed in 13.7% (60/437) of children with a brain tumor. In 50/60 children (83.3%) nystagmus was an incidental finding at the clinical examination and only in 10/60 children (16,7%) were nystagmus noticed by patient/caregivers prior to the clinical examination. In 38/60 children nystagmus was observed before the brain tumor diagnosis, most often (16/38, 42%) the same day as the diagnosis was made. In 22/60 children nystagmus was found after the brain tumor diagnosis (prior to any treatment) with a median of four days (range 0–47) after the brain tumor diagnosis. Nystagmus was most commonly binocular (56/60, 93.3%) and gaze-evoked (43/60, 71.7%). The median number of additional symptoms and/or clinical findings was five (range 0–11). Conclusion Nystagmus is frequent in children with brain tumors and is typically accompanied by other symptoms and clinical signs. However, it is often first recognized by the ophthalmologist late in the time course. Therefore, awareness of nystagmus and the importance to test for gaze-evoked forms might contribute to increased suspicion of brain tumor and thereby faster diagnosis.