Approach to a suspected brain tumor (pediatrics) Quiz: Ace Your Exams

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A 13-year-old girl presents to the clinic with a 2-month history of headaches. The pain is described as dull and pressure-like, typically occurring in the early morning and lasting about an hour, resolving spontaneously. The headache is usually associated with non-bloody, non-bilious emesis and visual disturbances. There is no history of seizures, loss of consciousness, fever, or neurological deficits. Birth, family, and developmental history are noncontributory, and immunizations are up to date. Temperature is 37°C (98.6°F), pulse is 78/min, respirations are 19/min, blood pressure is 110/75 mmHg, and oxygen saturation is 97% on room air. Height and weight are at the 5th percentile. Bilateral papilledema is noted on fundoscopic examination. Neurological examination reveals normal strength, gait, and reflexes. Genital and breast exams reveal Tanner stage 2 pubertal development. Magnetic resonance imaging (MRI) of the brain reveals a heterogenous solid and cystic suprasellar mass, and a biopsy is scheduled. Which of the following additional diagnostic studies should be ordered? 

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