Volume 2

An American text-book of the diseases of children ... / edited by Louis Starr ; assisted by Thompson S. Westcott.

Date:
1898
Catalogue details

Licence: Public Domain Mark

Credit: An American text-book of the diseases of children ... / edited by Louis Starr ; assisted by Thompson S. Westcott. Source: Wellcome Collection.

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    frontal or occipital, without reference to the seat of the tumor. Occasionally the pain is distinctly and constantly localized at one place, and here there may be tenderness of the scalp and head on percussion, this being under such cir- cumstances of value as a localizing symptom. The pain is dull and continuous or intermittent and severe. Infants probably suffer less, owing to the greater distensibility of the skull; and in them pain may be inferred from restless- ness, irritability, sharp cries, sleeplessness, and burrowing movements of the head. Nausea and Vomiting.—These symptoms are noted in from one-fifth to one-fourth of the cases. They are commoner in children than in adults. The vomiting, may occur without nausea, irrespective of the taking of food, and intermittently or more or less continuously. It may be associated with vertigo, and frequently accompanies severe headache. It is often brought on by move- ment of the body. It is most common in cerebellar tumor. Vertigo.—This symptom is not uncommon, and is particularly frequent with cerebellar neoplasms. As it accompanies so many divers affections out- side of the cranial cavity, it cannot be regarded as of great diagnostic value. Optic Neuritis.—The optic nerves are affected, according to Starr, in 80 per cent, of cases of brain-tumor, and hence this constitutes one of the most significant objective symptoms. It must be always looked for, since neuritis may exist to a very great extent without visual defect. Usually double, it may at first appear in one eye, and generally one disk is more affected than the other. This symptom, too, is more common in tumors of the cerebellum and at the base of the brain. It must be remembered, however, that it occurs in other disorders beside brain-tumor, such as meningitis, hydrocephalus, and abscess. Optic atrophy may follow the neuritis. Convulsions.—Spasms are of frequent occurrence in the brain-tumors of childhood. They may be slight (petit mal) or severe, limited to certain mem- bers, or general, infrequent or frequent—twenty to thirty per day. General convulsions have no significance as to the seat of the lesion, nor can partial epilepsy (Jacksonian) always be relied upon to indicate the situation of the tumor. Mental Changes.—In at least half of the cases some psychical disturbance is manifest. This is naturally much varied according to the amount of brain injury and the age of the child. It may show itself in mere fretfulness and irritability, or there may be dulness, lethargy, hebetude. In some cases there may be delirium, maniacal excitement, or an enfeeblement of the mental pro- cesses amounting to dementia. Somnolence is a common symptom in children. As the disease progresses this often deepens into coma. Tremor, insomnia, fever, neuralgia, slow or rapid pulse, disturbances of respiration, and constipation, are symptoms occasionally observed in certain cases, but from these no significant deductions can be made. Increase of head- temperature., local or general, as measured by the surface thermometer, has not yet been sufficiently studied to be practically available as a symptom in brain- tumor. Localizing Symptoms.—After due and careful consideration of these general symptoms, we must examine the focal manifestations, which are either irritative or destructive. Localizing symptoms depend altogether upon the seat of the tumor, whether adjacent to the motor area of the cortex (partial epilepsy) or in the motor tract (monoplegia or hemiplegia); in the sensory areas or tracts (anaesthesia, hemiansesthesia, hemianopsia, etc.); in motor or sensory speech-centres or tracts (aphasia in various forms); or, finally, impinging upon cranial nerve nuclei or trunks (paralysis of ci'anial nerves).