Table 7.

A proposed acronym (LOW-OR-PAY) to facilitate diagnosis of childhood brain tumors, including low-grade glioma

Letter	Stands for	Explanation/Example
L	Local (focal) symptoms	Any focal motor, sensory, or facial symptom should be taken seriously even if relapsing and remitting
O	Ongoing (long-term) symptoms	Symptoms that continue for months or years should not exclude brain tumor
W	Worsening of existing symptoms	Unexplained worsening of existing seizure or headache Behavioral or migraine headaches
O	Other, associated signs/symptoms	Vomiting with headache, headache with behavioral issues, visual symptoms with head tilt, or any combination of 2 or more neurologic signs/symptoms
R	Relapsing and remitting	Recurrence of arm weakness that resolves after physical therapy Recurrence of headache that improves with pain medication Recurrence of vomiting after treatment for gastroenteritis On and off head tilt, headache, or visual symptoms
P	Persistent	Sinus headache that persists after resolution of presumed sinusitis
A	Altering (changing); Adolescence	Change in school performance, sleep patterns, or behavior A monthly headache that becomes daily A change in frequency or type of existing seizures An unexplained change in corrective glasses prescription Adolescents should receive extra attention
Y	Young (New)	Any new symptoms should be followed for resolution after 2–3 weeks

LOW OR PAY may be recalled by using the mnemonic “Think LOW-grade glioma, OR patient will PAY the price.”