NEOPLASMS OF THE PERIPHERAL NERVES The extension of neoplasms to peripheral nerves and the occurrence of nodules (neuromata) within the nerves are subjects that chiefly in terest the surgeon and arc of no importance in children's practice. Similarly the rare occurrence of multiple painful nodules in the nerves (tubercula dolorosa) and of a congenital plexiform neuroma of the trigeminus are without significance to the pediatrist. On the other hand, general neurofibromatosis or llecklinghausen's disease which, althouph extremely rare, has been observed in the child (Berggriin) and which probably depends on congenital predisposition, deserves brief mention in a work on pediatrics. The disease may be a hereditary or rather a family one, and for this reason may be included among the above described endogenous diseases.
The disease consists in the appearance of numerous nodules and pigmented patches in the skin and in tumors of the nerve trunks. Some
times, though not always, there is spontaneous pain or pain on pressure in the skin, and the muscles are sensitive; quite often the disease runs its course without producing any subjective symptoms.
The gravity of the affection may be much increased if the nerve tumors make their appearance in the roots of the spinal and cranial nerves. The symptoms are quite atypical and difficult to interpret and may produce a clinical picture resembling that of tumor of the spinal cord or brain, and lead to a fatal termination. The point of exit of the auditory nerve from the base of the brain is a favorite localization for this type of brain tumor, which sometimes is solitary cneurofibroma of the auditory nerve). When none of the cranial nerves are involved, the disease runs a slowly progressive course, although temporary re mission and even involution of the tumor have been observed.