What are the effects and signs?
- Symptoms of brain tumours affecting the frontal lobe
- Symptoms of brain tumours affecting the parietal lobe
- Symptoms of brain tumours affecting the temporal lobe
- Symptoms of brain tumours affecting the occipital lobe
- Symptoms of brain tumours affecting the cerebellum
- Symptoms of brain tumours affecting the pituitary gland
Symptoms of brain tumours are often initially non-specific and can start intermittently before becoming more persistent and worsening in severity. Only a third of children are diagnosed with their condition within a month of their first symptom. The commonest symptoms in children over 2 years are:
- Headache, usually frequent, recurring and gradually worsening (approx 33%).
- Nausea/vomiting (approx 32%).
- Ataxia/poor balance and clumsiness when walking (approx 27%).
- Fits (approx 13%).
- Squint/double vision (approx 7%).
- Behavioural changes (approx 7%).
Children under 2 tend to present with even more non-specific symptoms such as ‘irritability’ or ‘failure to thrive’. Their most common presenting symptoms are:
- Macrocephaly -large head size for age (up to 40%).
- Nausea/Vomiting (approx 30%).
- Irritability (approx 24%).
- Lethargy (approx 21%).
- Head tilt (approx 7%).
- Developmental delay (approx 5%).
Brain tumours may cause raised intracranial pressure – usually as a result of a blockage in the circulation of the fluid that surrounds the brain and spinal cord (cerebrospinal fluid or ‘CSF’). This is termed ‘hydrocephalus’ and is sometimes referred to in lay terms as ‘water on the brain’ and presents with a particular pattern of symptoms including:
- Headache – may be severe, classically worse in the morning and on coughing or sneezing.
- Nausea and vomiting.
- Drowsiness - usually a late sign/symptom.
- Blurred vision and blindness – raised pressure causes damage at the back of the eye. When there is swelling at the back of the eye this can be seen when the eye is examined with an ophthalmoscope - the characteristic appearance is called ‘papilloedema’.
- In young children the bones of the skull are soft and pliable – their head circumference may expand to accommodate increased amounts of cerebrospinal fluid (CSF). An enlarged head is called ‘macrocephaly’.
Without adequate treatment raised intracranial pressure causes death within a short period.
In addition to general symptoms there may be other symptoms that relate to where the tumour is in the brain. The following list gives an indication of symptoms and signs by location and is not exclusive or specific for any given child.
The brain is divided into lobes as illustrated below. The diagram shows the right side of the brain seen from the side. Note the names and locations of the different lobes. This picture has been reproduced from the website: http://sciencealive.wikispaces.com/Human+Brain under Creative Commons Attribution Share-Alike 2.5 License
Childhood brain tumours are often grouped by the region of the brain they arise from. This includes supratentorial tumours; frontal, parietal, temporal, occipital lobe tumours and those in midline structures such as the pituitary gland, optic pathway, basal ganglia and thalamus. Infratentorial tumours or ‘posterior fossa’ tumours are more common in children than adults and include those arising from the cerebellum, IV Ventricle and brain stem.
Symptoms of brain tumours affecting the frontal lobe
The frontal lobes determine personality and contain the area called the motor cortex that controls movement of the muscles of the body (the motor cortex on the right half of the brain controls the left side of the body and vice versa). The frontal lobes are thought to be the area of the brain most involved in conscious thinking. Symptoms of tumours affecting the frontal lobe can include:
- Personality change.
- Disinhibition – loss of inhibition leading to offensive behaviour which is out of character for that child e.g. swearing, rudeness.
- Irritability.
- Aggression.
- Apathy – loss of interest in life.
- Difficulty planning or organising.
- Weakness of one side of the face or body.
- Problems walking.
- Difficulty speaking.
Symptoms of brain tumours affecting the parietal lobe
The parietal lobe contains areas responsible for the sensation of touch and association, this area enables fine judgement of sensation such as texture, weight, size. Symptoms of tumours in this area include:
- Loss of sensation in part of the body.
- Sensory or motor neglect – e.g. a child with right sided sensory neglect will not respond to a sound from the right, gesturing by someone standing on their right or a touch to the right side of the body. They will respond normally to these stimuli on the left side.
- Difficulty speaking or understanding speech.
- Problems with reading and/or writing.
Symptoms of brain tumours affecting the temporal lobe
The temporal lobe has many functions including processing of audio and visual information, comprehension and memory of verbal information. Symptoms of tumours in this area include:
- Fits – these may be called ‘temporal lobe epilepsy’ this type of epilepsy is often associated with strange feelings, smells or déjà vu sensations which accompany or precede a fit (often termed an ‘aura’).
- Short term memory problems.
- Inability to recall words.
Symptoms of brain tumours affecting the occipital lobe
This area is responsible for vision; symptoms include problems with or loss of vision on one side. Blindness that is caused by damage to the visual area of the brain is called ‘central’ or ‘cortical’ blindness.
Symptoms of brain tumours affecting the cerebellum
The cerebellum helps to coordinate balance, symptoms of tumours affecting the cerebellum include:
- Problems with balance and coordination.
- Intention tremor.
- Squint/ double vision.
- Abnormal eye movements – ‘nystagmus’.
- Nausea and dizziness.
- Raised intracranial pressure.
Symptoms of brain tumours affecting the pituitary gland
The pituitary gland is a small gland arising from the bottom of the hypothalamus at the base of the brain. This pea sized gland sits inside a bony cavity known as the sella turcica close to the optic chiasm (crossover of the optic nerves). It produces many hormones that control and regulate body processes such as growth, puberty, adrenal and thyroid functions. Symptoms of these tumours may arise as a result of abnormal hormone production –too much in ‘functioning’ tumours or too little in ‘non-functioning’ tumours. They may also compress important parts of the brain located next to the pituitary gland (e.g. optic nerves or hypothalamus). In children, tumours arising from either the pituitary or nearby structures are often termed supra or parasellar tumours and include; craniopharyngioma, germinomas and astrocytomas of the optic chiasm or hypothalamus and present with similar symptoms and signs as discussed below.
Symptoms may include:
- Arrested growth.
- Excessive growth.
- Precocious puberty.
- Delayed puberty.
- Menstrual irregularity in girls.
- Weight gain (morbid obesity).
- Failure to thrive.
- Mood swings (behavioural change).
- High blood pressure.
- Diabetes.
- Loss or restriction of visual fields and acuity.
- Excessive thirst and urine production (diabetes insipidus).
- Infertility in the longer term.
- Hypothyroidism (lethargy, cold intolerance, weight gain).
- Hypoadrenalism (underactivity of the adrenal glands).
- Raised intracranial pressure.
