Physical

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Increased intracranial pressure

A funduscopic examination reveals papilledema. Infants may have only optic pallor.
Palsy of cranial nerve VI is common and results in the inability to abduct one or both eyes.
Infants may demonstrate the setting sun sign, observed as an impaired upgaze and a forced
downward deviation of both eyes. Measurement of head circumference in infants with open sutures may
reveal macrocephaly.
Other signs
Strength and motor testing may reveal weakness and monoplegia or hemiplegia.
Localized deficits in truncal steadiness, upper extremity coordination, and gait may be
observed with tumors of the posterior fossa and basal ganglia.
Multiple and bilateral cranial nerve deficits, especially VI and VII; long tract signs; and ataxia
are associated with brainstem tumors.
Visual acuity is frequently reduced to less than 20/200 with optic gliomas. The pattern of visual
loss in those patients with intraorbital tumors is most commonly a decrease in central vision, whereas
bitemporal hemianopsia is most often noted in those patients with chiasmatic tumors. The involved eye
generally shows optic pallor and nystagmus. Mild proptosis is usually present with primary intraorbital
tumors.
Spinal astrocytomas often cause weaknesses of a variable extent and severity, ranging from
monoparesis to quadriparesis. Pain along the involved vertebral segment may occur when the patient
sneezes or coughs. Papilledema and hydrocephaly are present in 15% of patients and are attributed to
increased cerebrospinal fluid (CSF) viscosity from an elevated protein content.