Changes of temper should be always inquired for. At the beginning of many cerebral diseases the child often seems unaccountably wayward and capricious. He is fretful without cause, or spiteful, or sullen and morose.
These symptoms are not, however, confined to cases of brain affection. The same change is often noticed in chronic abdominal derangements, and may be a symptom of epilepsy.
Tremors, spasms, and paralysis are symptoms which derive their value from the connection in which they are found.
Tremors are sometimes a result of mere weakness, as when they occur in the late period of typhoid fever. In such a case they are general, and the condition of the patient is one of extreme debility. When they result from cerebral disease they are often confined to one limb or to a group of muscles. In such a case, if they are repeated, and occur always in the same part, they should excite suspicions of tubercle of the brain. If rhythmical, they would suggest disseminated sclerosis, although this is a rare disease in childhood.
Spasms or convulsive movements, both clonic (intermittent contractions) and tonic (persistent contractions) may be general or limited, like the tremors to one side of the body, to a group of muscles, or even to a single muscle. As a result of cerebral disease they are often so limited. Thus, if a child be subject to epileptiform convulsions which affect exclusively one-half of the body, some lesion (often a mass of cheesy matter) may be suspected in the opposite hemisphere of the brain. Still, a general con vulsion, as has already been remarked at the beginning of this chapter, is not necessarily a sign of disease of the brain ; for in certain subjects a very trifling and passing irritant is able to induce it. This subject is treated of at length in a separate chapter (see Convulsions).
Paralysis is commonly a consequence of disease of the brain or spinal cord ; but even this symptom may be sometimes referred to a less serious origin. Thus a temporary loss of power may follow a severe and pro longed attack of convulsions, and is then attributed to exhaustion of nerve force as a consequence of the seizure. This form of paralysis soon passes off. If it persist for a week or longer, it is probable that a lesion of the
brain has actually occurred. Again, facial paralysis may be the result of causes acting upon the facial nerve after its point of exit from the tem poral bone. An infant may be born paralysed on one side of his face from pressure of the forceps upon the trunk of the nerve ; and in older children rheumatic inflammation of the nerve-sheath from a chill may be followed by the same deformity.
Even paralysis due to cerebral or spinal disease is not always perma nent. When the patient survives, power in the affected limbs is often recovered more or less completely. Thus, paralysis due to myelitis affect ing the anterior cornua of the spinal cord (infantile spinal paralysis), at first very extensive, may be found in a few clays or weeks to have limited itself to one limb, or even to a single muscle. Again, a paralysis from cerebral hmmorrhage is often recovered from if the child survive ; and the mysterious form of paralysis which sometimes follows an attack of diph theria generally passes off completely after a time. The loss of power is often very partial, and affects special muscles. In cases of cerebral tumour it may be limited to the muscles of the eye or face.
The various forms of paralysis in children which result from clot, em bolism, or other shock to the brain, are usually accompanied by aphasia. With regard to this symptom it may be noted that loss of speech is of less value in early life, as indicating the seat of the lesion, than it is held to be in the adult. Indeed, in the young subject aphasia may be present although the brain itself is free from disease. It must be remembered that in a child of five or six years old the power of talking is a comparatively recent ac complishment, and that the utterance of any but the most simple phrase requires a distinct intellectual eflOrt. In many weakened states of the body—whether produced by general disease or special injury to the cere brum—the necessary effort cannot be made. Consequently, any shock to the system will in many children take away for a considerable time the faculty of articulate speech.