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Symptoms of brain tumours

Brain scan showing large primary brain tumour causing headaches.  Right panel after successful radiotherapy and chemotherapy.
Brain scan showing large primary brain tumour causing headaches. Right panel after successful radiotherapy and chemotherapy.

The commonest clinical presenting features of a patient presenting with a brain tumour are:

1. Symptoms or signs of raised pressure inside the head: these are headache, vomiting and pressure signs at the backs of the eyes (papilloedema) when the doctor looks with his ophthalmoscope.

2. Progressive loss of neurological function attributable to a progressive defect in one brain area e.g. the progressive loss of strength in one limb, progressive difficulty in speaking etc.

3. Late onset epilepsy – either focal fits (e.g. fitting of one limb) or generalised fitting (e.g. full blown fitting with loss of consciousness, called grand mal fitting).


The reasons for these three manifestations being the common mode of presentation of brain tumours is easy to understand when we think of what is going on inside the head. As a tumour grows, the pressure goes up inside the head as this is a closed compartment – the skull is rigid and cannot allow any expansion of brain containing a swelling tumour; therefore the pressure goes up and headache and vomiting are exhibited by the patient.


When a tumour arises and grows in a particular brain area, it destroys the function of that brain area and this is why progressive loss of neurological function (which is subserved by that brain area) is noted as the condition progresses.


Lastly, any tumour growing within the brain acts as an irritable focus, disturbing the smoothly established electrical neuronal circuits; it is for this reason that epileptic fits may be manifest and be the first symptom to draw attention to the tumour.


Other special types of brain tumour manifest in their own individual ways: Thus an acoustic neuroma will manifest with progressive hearing loss on the affected side and a functioning pituitary tumour may manifest because of the over-secretion of its hormone product e.g. acromegaly when it is an acidophil adenoma (vide infra).

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