With the development of our modern technological tools, the detection rate of brain tumors in children is increasing. However, often, children who are examined for intracranial tumors after going to the hospital have more serious symptoms. Tumors grow inside the skull and cannot be seen or touched. As a parent of a child, how can you know that a tumor has appeared in your child’s brain? Especially for some young children who are not yet able to communicate with their parents verbally, what actions and physical conditions of children can reflect the possible intracranial tumor, so as to remind parents to take their children to hospital for examination? Let’s learn about the common abnormal manifestations of brain tumor in children.
1. Vomiting
This is the most common manifestation of intracranial tumor in children. It is easy to occur in the early morning in the early stage, but with the progress of the disease, it occurs at any time of the day, and presents intermittent and recurrent characteristics. In children, vomiting in the form of jets from the mouth and nose, accompanied by headache, is common. We all know that this is a manifestation of increased cranial pressure, but in clinical practice, we often encounter about 10% of children with brain tumors who only have recurrent vomiting without headache; this is often due to vomiting caused by compression and irritation of the vomiting central nerve at the base of the fourth ventricle by the mass. Therefore, when a child has unexplained recurrent vomiting, especially when it is accompanied by headache or dizziness, parents should pay attention to bring the child for head imaging examination.
2.Headache
Headaches are very common in adults, and most of them are vasoneurotic headaches or neurosis. However, in children, the organic lesions in the headache are significantly higher than in adults, and the headache is accompanied by vomiting in severe cases. Infants or younger children are unable to express the headache to their parents and often show signs of irritability, head flapping, scratching their hair, and incessant crying. Parents should be aware that persistent irritability in the infant stage may indicate that the child has a headache, but the child is not yet able to communicate with you.
3. Vision loss and visual field defects
Vision loss is very common in children with brain tumors and is manifested as blurred vision. Children are easily noticed by parents when they cannot read the fonts on the blackboard at school. When younger children are playing, parents should consciously ask their children to grasp some designated toys to identify whether the infant is showing signs of hypermetropia. Visual field defects, which are the range of space seen without the head and eyes moving, have both horizontal and vertical visual fields, and some childhood brain tumors can cause centripetal narrowing of the visual field.
On examination, it is common for children to have optic papilledema often accompanied by hemorrhage, which can develop into secondary optic atrophy in a relatively short period of time, with severe impairment of vision. Because children are often unable to cooperate with the examination, it is sometimes necessary to ask the ophthalmologist to dilate the pupils and examine them under an examination lens. Before determining that the child is myopic, parents must do a brain tumor exclusion test with the help of a neurosurgeon.
4.Enlarged skull
In adults, the bone sutures have already healed bony, and the cranial sutures rarely open when the cranial pressure increases, while in children, the cranial bones are mostly fibrous healing, and the increase of intracranial pressure will cause the cranial sutures to open and thus increase the size of the skull. Parents must check the baby’s head circumference regularly after birth and check against the standard scale to see if the child has exceeded the normal value.
5. Diplopia
Diplopia is the formation of two overlapping images when looking at objects. This is caused by the increase of cranial pressure caused by brain tumor, which makes the bilateral spreading nerve of the eye squeezed and paralyzed to different degrees. It is often a manifestation of internal obliquity (often called “opposite eye”) and diplopia.
6. Cervical resistance and forced head position
Cervical resistance is simply understood as cervical tonicity. Intracranial tumors in children are usually found in the posterior cranial fossa, which can directly or indirectly stimulate the cervical nerve roots and cause cervical resistance. Sometimes, children with brain tumors force their head and neck to be fixed in one position, often in the lateral prone position, which is a spontaneous compensatory mechanism of body functions to keep the cerebrospinal fluid circulation smooth; if they change to the other side of the body in the prone position, the tumor will exert pressure on the healthy tissues and obstruct the cerebrospinal fluid circulation. For this kind of children, parents must be vigilant, otherwise there is always a risk of brain herniation.
7.Seizure
Parents must pay attention to epilepsy that occurs without any trigger, whether it is a grand mal seizure or a twitching of a certain limb or a limited facial twitching. These seizures are not the same as the common “febrile convulsions” that occur with high fever. Because meningiomas are less common in pediatric patients than in adults, the probability of epilepsy due to brain tumors is only 10%, but the symptoms of epilepsy should not be ignored, at least CT and EEG should be done to exclude intracranial tumors.
8.Alteration of consciousness
When the intracranial pressure is increased due to tumor, children often show irritability, easily irritated, crying for no reason; some children show drowsiness or even apathy. Because of the strong compensatory ability of children for the increased cranial pressure, the symptoms will be hidden under the manifestation of altered consciousness. If there is very poor spirit, slow pulse and elevated blood pressure, it means that they have entered into pre-consciousness, and must be treated immediately for emergency cranial pressure lowering treatment, otherwise it will cause sudden deterioration of the condition.
9. Unstable walking
Parents should be careful of the possibility of brain tumor if the gait is unstable, scissor-like gait, inflexible movement, poor coordination, uncoordinated movement of ipsilateral limbs, and inability to stand steadily when standing with hands stretched forward and leaning to one side, and if the cranial pressure increases, it often indicates that there may be tumor in the cerebellum or brain stem.
10. Drinking and urinating more
Suprasellar germ cell tumor is almost 100% the first symptom, and craniopharyngioma will appear at a lower incidence in the late stage. For children, do not take primary urinary tumor as the diagnosis, but make sure to do imaging examination to exclude the possibility of intracranial tumor.
11.Abnormal growth and development
This is a manifestation known to many of us. When the tumor affects the pituitary gland and lower thalamus, there will be obvious manifestation in the vigorous growth and development stage of children. Developmental delay, short stature, underdeveloped sexual characteristics, precocious puberty and gigantism are all manifestations of abnormal growth. It is worth noting that a small percentage of chronic tumors, which can make children obese and developmentally delayed, are a minority but need to be noticed.