The symptomatology of glioma and sarcoma does not differ materially in the child from that of the same conditions in the adult. The presence, of such a neoplasm should be suspected when in a previously healthy vigorous child symptoms of tumor develop rapidly. The height of the disease is reached in a shorter time than is usually the case with tubercle. In cases of neoplasms situated in the cerebellum and in the posterior cranial fossa, which are so frequent, both the general, and the focal symptoms early assume great importance.
Cystirercus gives rise to remarkably few local symptoms; »ot even pressure symptoms are always pronounced. Soine of the many Mfferent symptoms of these tumors are headache, vomiting, general or localized convulsions, muscular spasms (often associated with twitching in the shoulder and in the face), mental confusion, depression, as well as typical cerebellar and bulbar symptoms. Choked disc is usually absent. In eases of cysts floating free in the ventricles alternation between the picture of grave disease and good health are not rare, 80 Mlle h so that the patients am regarded as hysterical or neurasthenic until, to the surprise and discomfiture of the physician, severe permanent symptoms (blindness) or death suddenly occur.
Tumors of the hypophysis, mostly in the form of adenoma, rarely psammoma or sarcoma, have but little significance in children. Adenoma of this organ, which develops in later life, gives rise to a peculiar clinical picture, that of acromegaly, the cardinal symptoms of which are increase in the size of the hands, feet and bones of the face; thickening of the skin, disinclination to work, apathy, more rarely bulimia, polydipsia, parmsthesia and pain. The signs of tumor are not necessarily present. As a rule the thymus gland persists. The course is slow and ehronic, and the disease is not directly fatal. The symptoms of this condition tire due not to the presenee of the neoplasm but to the disturbance of the internal secretion of the hypophysis; in fact, the presence of the hypophyseal tumor in acroniegaly is now regarded rattier as a secondary phenomenon of the disease than as its cause, The course of brain tumor in children is not less grave than in adults. It is true that the course is not rapid, in the ease of brain tubercle par ticularly, which is so frequent ; much so in fact, that the slow develop ment of the disease is a valuable diagnostic point between tubercle on the one hand, aud glioma and sarcoma on the other. Death in cases of tubercle is very frequently due, not to the effects of the tumor itself, but to a tubereulous meningitis or a general miliaiy tubereulosis. Rap
icily growing tumors of the posterior cranial fossa, particularly sarcoma and glionia, may cause sudden death. In general, however, a duration of several years is not uneommon in cases of brain tumor in childhood, particularly cases of tuberele; toward the end the symptoms assume a violent eharaeter and death occurs within a few days.
Whether recovery in cases of brain tumor is possible is exceedingly doubtful (syphilitic diseases excepted). In the ease of tubercle there is of course a possibility of calcification taking plaee but, judging from the autopsy findings at our disposal, it appears to be a very rare event. Cystieereus, on the other hand, undoubtetlly does calcify, with subse quent recovery. Of clinical examples of recovery from a tumor there is no lack and I have personally seen such cases. They must, however, be accepted with great caution; for it must be remembered that long periods of latency are among the possibilities in cases of brain tumor (tubercle) anti, on the other hand, it is very probable that circum scribed encephalitis, in which recovery is undoubtedly possible, may present a clinical picture in every respect similar to that of tunior (see encephalitis).
The differential diagnosis has but a limited field in childhood. Neoplasms occurring in children suffering from hereditary syphilis ought not to be classified as tumors, because they are rarely uncomplicated and it is practically impossible to differentiate clinically between gumma, encephalomalacia and a circumscribed meningitis. Cases of tumor with herniplegia and paraplegia are often mistaken for cerebral infantile palsy. The diagnosis rests on the ophthalmoscopic findings, the history (slowly acquired affections are not cerebral infantile palsies), and the course of the disease, which is progressive in tumor and retrogressive in infantile palsy. It has already been mentioned that brain tubercle is not infrequently confounded with meningitis, especially the hfemor rhagic form of the disease. It has also been pointed out that the first symptoms of a tumor, and the variable picture produced by- cysticercus floating free in the ventricles inay simulate hysteria or neurasthenia. Headache, vomiting, and signs of general malnutrition quite frequently suggest the diagnosis of gastric trouble, and the presence of a tumor is recognized only- by the discovery of choked disc, by the progressive course, and by the focal symptoms which sometimes make their appear ance. For the differential diagnosis between brain abscess and encepha litis, see the respective sections.