There is usually loss of special sense. Deafness may occur, and im pairment of vision is a frequent symptom. Amaurosis is said to be most common when the growth occupies the anterior lobes ; in which case the straight sinus is compressed and the escape of blood obstructed from the veins of the eye. Impairment of vision is not, however, confined to these cases. It is often seen when the tumour is seated in the posterior lobes or in the cerebellum. The disturbance of sight is then attributed to com pression of the versa magna Galeni ; and the interference with the circula tion induces at the same time a copious effusion into the lateral ven tricles.
Ophthalmoscopic examination of the eye almost always shows impor tant changes which affect the retina of both eyes. We find that the disk is swollen and blurred at the margins, with tortuosity of the central vein. If the child live long enough the optic nerve may atrophy.
Unless chronic meningitis become developed, or there are numerous tumours in the cerebral substance of both hemispheres, intelligence is but little affected. Still the child generally shows some change in character. He is fretful and perverse, or morose in temper, and gives much trouble in the nursery and school-room.
In slowly growing tumours the development of the symptoms is very gradual. These are the cases which are comparatively easy to recognise. 'We find a history of headache, of tremors, or convulsive attacks, followed at a longer or shorter interval by paralysis more or less complete, involv ing often special senses, and implicating the cerebral nerves as well as those of the spine.
A good illustration of the symptoms is seen in the following case : A little boy, aged five years and a half, who had had a slight conver gent squint since the age of two years, but had otherwise enjoyed perfect health, began to suffer in the month of June from peculiar symptoms of illness. A short time previously he had had a severe fall upon his head. The accident shook him for a time, but its effects appeared to pass off com pletely. Early in June, however, the boy began to complain of headache, which came on in severe paroxysms, so that he cried out with the pain. Almost at the same time his limbs began to get weak. His arms trembled when he took anything up in his hands, and he tottered as he walked. Very soon afterwards his sight began to fail, and he used to vomit, espe cially at night ; but his other senses seemed perfect, and his intelligence was unimpaired. After a time the severity of the headache diminished,
but the other symptoms were intensified, so that by November, when he was admitted into the East London Children's Hospital, he was almost blind and had quite lost the power of walking.
On admission (November 16th) the muscles were well nourished and seemed firm, but any voluntary movement excited a kind of spasm, during which both arms were drawn up, seemed to get rigid, and were agitated by a peculiar trembling which lasted for one or two minutes. The legs also appeared very weak. 'When placed upon his feet he could not stand without support, and when he tried to do so a tremor was noticed in the legs like that which affected the arms. There was no paralysis of the face, and the tongue was protruded in the middle line. He had only partial control over his sphincters, for when he felt the desire to evacuate the bowels or the bladder, he usually passed his water or motions in the bed before there was time for any one to come to his assistance. He was quite blind, and an ophthalmoscopic examination showed the presence of optic neuritis. His other senses were perfect, and his intelligence was quite equal to that of other children of his age. His temperature at 9 A.M. was 102° ; pulse, 138.
For some days after admission the boy continued in much the same state. The temperature remained between 100° and 101°, rather higher at night than in the morning. The tremors persisted, and the weakness became more and more marked. In about ten days, however, some rigidity of the left arm was noted. The elbow became slightly stiff, and he kept his left hand tightly clenched over the inverted thumb. He used only the right hand voluntarily, although if made to hold anything in the left he could do so.
On November 28th control over the sphincters was quite lost, and he passed his water in the bed. The bowels were usually costive. There was rigidity and tremor of both arms, the head was retracted, and the back was kept rigidly extended. Still, intelligence remained unimpaired. Some times the boy answered questions in a sleepy tone, but he perfectly under stood all that was said to him. He made no complaints. Temperature at 9 A.M., 104.6° ; pulse, 144. At 6 p.m., temperature, 104.4° ; pulse, 148.