26th June 2023

Common symptomatology of brain tumours

The symptoms of brain tumours are usually progressive, and you may meet a patient at the start of their journey or when their tumour has progressed to an advanced stage. Therefore, it is important to understand the red flag symptoms that may be associated with a potential brain tumour diagnosis and have a low threshold for investigation as the symptomatology may be subtle.

As with all pathologies involving a high metabolic activity, lethargy and weight loss can be a common feature due to the increased energy expenditure by the growing lesion. Social withdrawal, poor sleep and behavioural changes can be some of the subtle changes reported by the patient or their loved ones.

Raised intracranial pressure (ICP) associated with a space-occupying lesion in the brain can cause a variety of symptoms. Headaches are a commonly reported symptom; classically, the headache is worse in positions of increased ICP, such as when straining, lying down, or in the early morning. Nausea and vomiting are other common symptoms caused by raised ICP. Papilloedema may be seen on fundoscopy (see image below) and is another sign of increased ICP. This can be experienced as blurred or double vision; a bulged optic disc, blurring of disc margins and microhaemorrhages may be seen on fundoscopy.

Depending on the location of the lesion, focal neurological deficits in an upper motor neuron pattern may be seen, including numbness, weakness, spasticity, and hyperreflexia. Vertigo or gait disturbance may occur due to pressure on, or involvement of, the cerebellum. Visual loss can be experienced if the optic nerve is compressed by the tumour, or due to surrounding oedema.

Seizures are experienced in up to 80% of patients with brain tumours due to disruption of the normal impulses of the neurons in and around the tumour, and the compression of surrounding structures.

Retinal image showing evidence of papilloedema

Image Source: Wikimedia Commons (2011). Papilledema, Licensed under a creative commons licence. Available for free at: https://commons.wikimedia.org/wiki/File:Papilledema.jpg (Accessed on: 30 January 2023).