Clinical Presentation and Diagnosis
Signs and Symptoms
Symptoms depend on the location and size of the mass. Common presenting symptoms include headache (often getting pregressively worse), seizures, personality or behavioral changes, dizziness and focal signs (e.g. motor, sensory or visual). Usually symptoms of benign or low grade tumors have gradual onset and are slowly progressive (i.e., weeks to months). Higher grade lesions are more likely to present with rapidly progressive headache and focal neurologic signs. Headache occurs in about half of all patients with intracranial tumors. Typically the headache is diffuse, but may be located in one hemisphere. Generally the headache is more noticeable on awakening in the morning and dissipates within a few hours.
The occurrence of seizures varies with the tumor type. Typically, the seizures are focal, but may become generalized. Other focal symptoms typically have a subacute onset and are progressive. The exception is a visual field deficit that may develop progressively but that often goes unnoticed by the patient until it contributes to an injury or automobile accident. Many, but not all, patients with an intracranial tumor and increased intracranial pressure have papilledema (illustrated in the image). Characteristics seen on funduscopic exams include blurring of the disc margins, congestion of retinal veins, and hemorrhages.
The major diagnostic study needed for a suspected brain tumor is cranial MRI. If a brain tumor is a diagnostic consideration, MRI with gadolinium enhancement is the test of choice; a normal contrast-enhanced MRI scan essentially rules out the possibility of a brain tumor.