SYMPTOMATOLOGY OF PINEAL TUMOURS 439 



of papilledema, which is usually very marked and presents itself as a very 

 early sign. Epileptiform fits also occur. 



Signs are produced in the cranial nerves as the result of the raised 

 intracranial pressure. The third ventricle is commonly affected, and 

 double vision and strabismus are frequently present. The Vlth nerve is 

 also involved. There is paralysis of the external rectus on either or both 

 sides, with a convergent strabismus. The olfactory nerve is not affected. 

 The Vth nerve may be affected, giving rise to a weakness of the muscles 

 of mastication and sometimes sensory loss on that side of the face. . 



Facial paralysis is seen quite commonly, and is either produced by 

 the local extension of the growth or from damage to the nerve resulting 

 from the raised intracranial pressure. 



Deafness is common, and has already been mentioned. 



The nerves IX, X, XI, and XII are not usually affected ; only if the 

 cerebellum is extensively invaded will they be pressed upon and give 

 rise to their characteristic physical signs. 



3. General Signs. — Pineal tumours associated with general somatic 

 changes are almost confined to the male sex. The disturbances of growth 

 associated with pineal tumours affect chiefly the genital organs, but are 

 often associated with adiposity and sometimes with general and sym- 

 metrical overgrowth. 



Hypertrophy of the penis and testes, with growth of pubic hair and 

 precocious sexual instinct, have been observed with most tumours classed 

 as teratornata, as well as with simple, benign, and malignant tumours. 

 The testicles show a marked increase in the size and number of the inter- 

 stitial cells. The breasts enlarge, and one case has been reported of a 

 secretion of colostrum in a boy aged 4, associated with testicular enlarge- 

 ment. 



Increase of hair occurs also on the lips and chin and in the axillae. 

 Deepening of the voice may take place. 



The adiposity which occurs has been observed with all varieties of 

 pineal tumours, and cannot be distinguished clinically from hypophyseal 

 obesity — probably because, as already pointed out, it is in both cases due 

 to hypothalamic involvement. The adiposity is proximal in distribution ; 

 it is marked over the shoulders and pelvic girdles, with considerable 

 enlargement of the breasts. The buttocks, thighs, and abdomen also 

 show heavy deposits of fat. 



Physiological experiments seem to point to the fact that injection of 

 pineal extracts in chicks and guinea-pigs causes a general increase in 

 size, with genital overgrowth and sexual precocity, but the evidence is 

 still not completely convincing. 



The possibility is that the pineal gland normally facilitates growth in 



