A comprehensive clinical examination is the basis for selecting further diagnostic steps:
- General physical examination – including blood pressure, pulse, body weight, height; further:
- Inspection (viewing).
- Skin, mucous membranes and sclerae (white part of the eye).
- Gait pattern [gait disturbances]
- Inspection (viewing).
- Ophthalmic examination – including ophthalmoscopy (ophthalmoscopy) of the back of the eye [visual disturbances; papilledema (swelling (edema) at the junction of the optic nerve with the retina, which is noticeable as a protrusion of the optic nerve head; congestion papilla usually bilateral)?]
- ENT medical examination – for dysosmia (olfactory disorders).
- Neurological examination – mandatory with assessment of reflexes, motor function and sensitivity [paresis/paralysis].
- When examining children, the following targeted tests are recommended for the neurological examination:
- Gait pattern while walking (if possible, also running).
- One-leg stand
- Tightrope walk (placing one foot in front of the other on an imaginary line; forward and backward).
- Finger–nose test with eyes closed (dysmetria test).
- Results:
- Eumetry – target is hit
- Hypermetry* – movement goes beyond the target
- Intention tremor* – increasing tremor when approaching the target.
- Hypometry* * – goal is not (completely) achieved
* indicative of dysfunction of the cerebellum* * mostly consequence of paralysis of the respective arm.
- Results:
Further diagnostics depending on the possible tumor localization:
- Posterior fossa (about two-thirds of all brain tumors in children): examination for oculomotor dysfunction (double vision, saccades (rapid, jerky backward movements of the bulbi after an eye movement in which an object is fixed.) and pathological nystagmus (rapid rhythmic eye movements)).
- Supratentorial (above the cerebellar peduncle, i.e., in the middle or anterior cranial fossa; about one-third of brain tumors in children): specific neurological deficits (paresis and sensory deficits are possible).
If in doubt, re-visit in 4 weeks and repeat the examination!
- When examining children, the following targeted tests are recommended for the neurological examination:
Square brackets [ ] indicate possible pathological (pathological) physical findings.
