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Signs & Symptoms

Low-grade astrocytomas (LGAs):

  • Generally present with a long history of signs and symptoms
  • Often non-specific and non-localizing initially

School age children may present with:

  • Personality changes
  • Declining academic performance
  • Fatigue
  • Intermittent headaches related to increased intracranial pressure (ICP)


High grade astrocytomas generally have a much shorter history of these problems prior to presentation.


Raised Intracranial Pressure

Three symptoms and signs (RED flags) for increased ICP may also develop:

1. Headaches:

  • Severe, progressive
  • Awaken the child at night
  • Associated with or relieved by morning vomiting
  • Worse first thing in the morning and when the patient coughs.

2. Abducens (cranial nerve VI)  palsy“False localizing” sign:

  • Due to effect of increased ICP on the course of CNVI
  • This nerve has a long intracranial course up the clivus and is easily affected by pressure.

The picture above shows a left lateral rectus (VI cranial nerve) palsy.

3. Papilledema




This is optic disc (optic nerve head) swelling secondary to raised intracranial pressure

Results from long-standing increased ICP

Appearance on retinal examination:

  • Optic disc is swollen and elevated
  • There is venous engorgement (hyperemia) of the disc
  • Indistinct, blurred disc margin
  • Venous congestion develops with hemorrhages around the disc.
  • Spontaneous venous pulsations are lost

There is classically no visual loss secondary to papilledema.


Below is an image of papilledema:


Cushing's Triad:

The combination of these three physical signs means that the raised intracranial pressure is very severe and there is impending brainstem herniation:

1. Abnormal respirations

  • Change in respiratory pattern with irregular respirations

2. Hypertension

  • Progressively increasing systolic blood pressure
  • An increase in the difference between systolic and diastolic pressure over time

3. Bradycardia


Infant Presentation:

Infants with astrocytoma often present with non-specific problems such as:

  • Irritability
  • Feeding difficulties
  • Failure to thrive
  • Gross motor delay or regression
  • Increasing head circumference, bulging fontanelles and prominent scalp veins
  • Parinaud’s  syndrome.


Parinaud’s syndrome:

Physical findings are related to increased ICP in the dorsal midbrain:

  • Paralysis of up gaze
    • This vertical palsy is supranuclear, so a doll’s head maneuver may elevate the eyes, but eventually all upward gaze mechanisms fail
  • Pseudo-Argyll Robertson pupils
    • Pupils respond poorly to light but will constrict with accommodation
  • Nystagmus
    • Attempts at upward gaze often produce this phenomenon
  • Upper eyelid retraction (Collier's sign)


Parinaud's may be associated with cranial nerve IV palsy, resulting in “down and out” deviation of the affected eye and often accompanied by a compensatory head tilt to the contralateral side.




As the tumor progresses, symptoms may relate directly to areas of brain involvement:

  • Posterior fossa lesions are associated with:
    • Ataxia
    • Clumsiness
    • Intention tremor
  • Hemispheric tumors involving the motor cortex may cause:
    • Focal motor deficits
    • Seizures
  • Astrocytomas of the visual pathway often cause:
    • Visual deficits



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