Symptoms of brain tumors in children

Brain tumors

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

Neurological symptoms in children with brain tumors depend more on the tumor location than on the histological structure of the neoplasm. The child's age 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 indirect delay in the outflow of cerebrospinal fluid and increased intracranial pressure.

The main clinical symptoms of brain tumors in children

• Headache (in young children, this may manifest as increased irritability).
• Vomit.
• An increase in the size of the head in newborns and young children due to increased intracranial pressure.
• Visual disturbances:
  • decreased visual acuity;
  • diplopia due to paralysis of the sixth pair of cranial nerves (in young children, diplopia is manifested by frequent blinking or intermittent strabismus);
  • swelling of the optic disc due to increased intracranial pressure;
  • Parinaud's syndrome (a combination of paresis or paralysis of upward gaze with convergence paralysis);
  • loss of visual fields due to damage to the visual pathways.
• Cramps.
• Mental disorders (somnolence, irritability, personality changes).
• Impaired gait and balance.
• Endocrinological disorders.
• Diencephalic syndrome (developmental delay, cachexia or weight gain).

Increased intracranial pressure

Increased intracranial pressure is one of the early 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 become clinically apparent earlier, when their size is still small.

The first signs of increased intracranial pressure are often non-specific and non-localized, developing subacutely. School-age children typically experience poor academic performance, fatigue, and complaints of acute paroxysmal headaches. A classic headache with increased intracranial pressure occurs when getting out of bed, is relieved by vomiting, and decreases during the day. The duration of headaches before diagnosis is usually less than 4-6 months, by which time additional symptoms associated with the tumor appear - irritability, anorexia, developmental delay; later - a decrease in intellectual and physical abilities (sometimes these signs appear at the onset of the disease). It is important to measure the circumference of the child's head, since the cranial sutures remain unclosed during the first few years of life, and chronic increased intracranial pressure leads to macrocephaly. Examination of the fundus can reveal signs of optic disc edema, clinically manifested by periodic "blurring" of vision. In children with increased intracranial pressure, the “setting sun” symptom (impaired upward gaze) can also be observed.

Symptoms of infratentorial tumors

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

Symptoms of supratentorial tumors

In children, the manifestations of supratentorial tumors may not depend on their size and location. Focal symptoms usually precede an increase in intracranial pressure. Non-specific headaches may be associated with early cortical symptoms and the presence of seizure episodes. Grand mal seizures are possible, as well as milder episodes with incomplete loss of consciousness (complex partial seizures) or transient local symptoms without loss of consciousness (partial seizures). Hemiparesis and hemianesthesia, loss of visual fields are possible. In some patients with tumor processes in the frontal or parieto-occipital lobes, with damage to the third ventricle, only an increase in intracranial pressure is noted.

Visual field examination is indicated to map and monitor any damage to the visual pathway.

Midline supratentorial tumors can cause endocrine disorders due to their effect on the hypothalamus and pituitary gland. Diencephalic syndrome in patients aged 6 months to 3 years with tumors of the hypothalamus or third ventricle is manifested by developmental delay and cachexia.

About 15-45% of primary brain tumors, especially embryonic and germ cell tumors, have disseminated to other parts of the CNS by the time of diagnosis. Neurological impairment sometimes obscures the symptoms of the primary tumor.

Spinal cord tumors

Spinal cord tumors in children account for 5% of all CNS tumors. They can be located in any part, causing compression of the brain matter.

Typical complaints include back pain (in 50% of cases), which increases in the supine position and decreases in the sitting position. Most spinal cord tumors are accompanied by muscle weakness, the involvement of certain muscle groups depends on the level of spinal cord damage.

The most common symptoms and syndromes of spinal cord tumors are: resistance to trunk flexion, spasm of the paravertebral muscles, deformation of the back (progressive scoliosis), gait disturbance, changes in reflexes in the form of a decrease in the upper limbs and an increase in the lower limbs, sensory disturbances corresponding to the level of damage (in 30% of cases), positive Babinski's sign, dysfunction of the sphincters of the bladder and/or anus, nystagmus (with damage to the upper parts of the cervical spinal cord).

Spinal cord tumors are divided into two groups.

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

Vertebral tumors may invade the spinal canal, causing epidural compression of the spinal cord and paraplegia (eg, Langerhans cell histiocytosis affecting the thoracic or cervical spine, Ewing's sarcoma).

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