Symptoms of brain tumors in children

Tumors of the brain

The most frequent clinical manifestations of brain tumors are increased intracranial pressure and focal neurological symptoms.

Neurological symptoms in children with brain tumors depend more on the location of the tumor than on the histological structure of the neoplasm. The age of the child at the time of the disease also affects the clinical picture.

Neurological disorders are associated with direct infiltration or compression of normal brain structures, or with mediated delayed outflow of cerebrospinal fluid and increased intracranial pressure.

The main clinical symptoms of brain tumors in children

• Headache (in young children may manifest as increased irritability).
• Vomiting.
• Increased head size in newborns and young children due to increased intracranial pressure.
• Visual disorders:
  • decreased visual acuity;
  • diplopia due to paralysis of the sixth pair of cranial nerves (in young children, diplopia manifests itself with frequent blinking or intermittent strabismus);
  • edema of the optic nerve due to increased intracranial pressure;
  • Parino syndrome (combination of paresis or paralysis gaze up with paralysis of convergence);
  • loss of visual fields due to damage to the visual pathways.
• Convulsions.
• Mental disorders (somnolence, irritability, personality changes).
• Violation of gait and balance.
• Endocrinological disorders.
• Diencephalic syndrome (lag in development, cachexia or weight gain).

Increased intracranial pressure

Increased intracranial pressure is one of the earliest clinical manifestations of a brain tumor characterized by a classic triad of symptoms: morning headaches, vomiting without nausea, strabismus or other visual disturbances. The appearance of symptoms and syndromes depends on the rate of tumor growth. Slowly growing tumors cause significant displacements of normal brain structures and can reach large sizes by the time the first symptoms appear. Rapidly growing tumors clinically manifest earlier, when their size is still small.

The first signs of increased intracranial pressure are more often nonspecific and not localized, develop subacute. Typical for school-age children is a decline in school performance, fatigue, complaints of acute paroxysmal headaches. Classical headache with increased intracranial pressure occurs when getting out of bed, is facilitated by vomiting, decreases during the day. The duration of headaches until the diagnosis is usually less than 4-6 months, by this time there are additional symptoms associated with the tumor - irritability, anorexia, delayed development; later - a decrease in intellectual and physical abilities (sometimes these signs occur already at the beginning of the disease). It is important to measure the circumference of the child's head, since cranial seams remain uncovered during the first few years of life, and a chronic increase in intracranial pressure leads to macrocephaly. Inspection of the fundus allows us to reveal signs of edema of the optic disc, clinically manifested by periodic "blurred" vision. Children with increased intracranial pressure can also observe the symptom of the "setting sun" (a violation of the sight upwards).

Symptoms of infratentorial tumors

With tumors located in the posterior cranial fossa, focal symptoms may be absent, symptoms of increased intracranial pressure dominate in the clinical picture (tumors localized in the cerebral hemispheres, in the early stages of development are often characterized by focal symptoms - seizures, loss of visual fields, neuropathy or dysfunction of cortico- spinal tract). Cerebellar tumors are characterized by abnormalities of gait and balance.

Symptoms of supratentorial tumors

In children, the manifestations of supratentorial tumors may not depend on their size and location. Focal symptoms usually precede increased intracranial pressure. Nonspecific headaches can be associated with early cortical symptoms and the presence of convulsive episodes. Large convulsive seizures are possible, as well as easier episodes with incomplete loss of consciousness (complex partial seizures) or transient local symptoms without loss of consciousness (partial seizures). Possible development of hemiparesis and hemianesthesia, loss of visual fields. In some patients with tumoral processes in the frontal or parieto-occipital lobes, with lesion of the third ventricle, only the increase in intracranial pressure is noted.

Investigation of visual fields is indicated for the purpose of mapping and tracking any lesion of the visual pathway.

Middle-located supratentorial tumors due to exposure to the hypothalamus and pituitary gland can cause endocrine disorders. Diancephalic syndrome in patients aged 6 months to 3 years with tumors of the hypothalamus or III ventricle is manifested by developmental lag and cachexia.

About 15-45% of primary brain tumors, especially embryonic and tumors from germinogenic cells, are disseminated to other parts of the central nervous system by the time of diagnosis. Neurological disorders in this case sometimes obscure the symptoms of the primary tumor.

Tumors of the spinal cord

Tumors of the spinal cord in children account for 5% of all tumors of the central nervous system. They can be located in any department, causing compression of the brain substance.

Typical are complaints of back pain (in 50% of cases), increasing in lying position and decreasing in sitting position. Most spinal cord tumors are accompanied by muscle weakness, the involvement of certain muscle groups depends on the level of damage to the spinal cord.

The most common symptoms and syndromes of spinal cord tumors are: resistance to bending of the trunk, spasm of paravertebral muscles, deformation of the back (progressive scoliosis), gait disturbance, changes in reflexes in the form of a lowering in the upper extremities and revitalization in the lower extremities, of cases), a positive Babinsky symptom, a violation of the function of the sphincter of the bladder and / or anus, nystagmus (with damage to the upper parts of the cervical spinal cord).

Tumors of the spinal cord are divided into two groups.

• Intramedullary tumors (astrocytomas, ependymomas and oligodendrogliomas).
• Extramedullary tumors:
  • intradural, associated with Recklinghausen's disease (teenage girls are more likely to have meningiomas);
  • extradural - more often neuroblastomas sprouting through the intervertebral foramen, and lymphomas.

Tumors of the vertebrae can sprout into the spinal canal, causing epidural compression of the spinal cord and paraplegia (for example, histiocytosis from Langerhans cells, affecting the thoracic or cervical spine, Ewing's sarcoma).

[1], [2], [3], [4], [5], [6], [7], [8], [9]