What are the symptoms of brain tumor? Brain tumors located at various sites in the brain can be pinpointed by their location by various signs and symptoms peculiar to that region of the brain. Thus it is important to understand these localizing signs.
Pre-frontal tumors are those confined to that part of the frontal lobe lying anterior to the pre-central gyrus. Tumors in this region are difficult to localize. Headache occurs early while papilloedema and vomiting develop late. These may be absent. Appearance of mental symptoms (Disorientation, intellectual dullness, irritability. Failure to appreciate the gravity of the situation, dementia) before appearance of signs of raised intracranial tension favors diagnosis of frontal lobe tumor.
Generalized convulsions occur in fifty percent of cases. Other signs include catatonia (patient becomes immobilized in one attitude for some time) and appearance of grasp reflex which is pathognomonic.
Post frontal tumors are characterized by pressure upon pyramidal tracts leading to weakness of opposite side of the body, most marked in the face or tongue. When the tumor extends putting pressure on olfactory nerves it leads to loss of smell power on that side. Optic nerve may be compressed leading to optic atrophy on the side of the lesion.
Tumors located in the pre-central area lead to symptoms of excitation and destruction of pyramidal tracts in the form of tonic and clonic movements of the opposite side of the body and motor weakness of the part of the body involved. Lesion in the para central lobule produces weakness of both lower limbs along with urinary retention.
Lesions in the parietal region produce sensory disturbances. Irritation of post central convolution produces sensory jacksonian fits consisting of paraesthesia such as tingling on the opposite side of the body corresponding to the focus of excitation. This may spread to other parts of the body in order of their representation in the convolution.
A post central lesion leads to sensory loss (postural sensibility, tactile discrimination, inability to recognize objects placed in the affected hand – astereognosis), while crude appreciation of pain, heat and cold is intact. There is also hypotonia and wasting as well as sensory ataxia of affected part.
When parietal tumors reach deep into white matter, thalamic over reaction may result leading to exaggerated response to unpleasant stimuli on the opposite side of the body.
Lesions in the left angular gyrus cause alexia (inability to read), agraphia (loss of ability to express meanings in written languages), finger agnosia and acalculia (inability to do mathematical calculations).
Symptoms of brain tumor are slight if the tumor is on the right side. When the tumor is placed anteriorly and involves uncinate gyrus, uncinate fits results when there are hallucinations of taste or smell usually unpleasant. Patient has a dreamy or dazed appearance and may stop what he is doing.
There may be involuntary licking or smacking of lips like tasting movements. Visual field defects may be produced in temporal lobe tumors. There are visual hallucinations and a crossed upper quadrantic hemianopia.
Further temporal tumors may cause tinnitis or auditory hallucinations. Left sided lesions cause aphasia in some percentage of cases and there is defect in naming objects. In more severe cases there is central aphasia with or without word deafness. Neighborhood symptoms include Hemiplegic signs most marked on the opposite side especially on face and less in arms and least in legs, conjugate deviation of the eyes to the opposite side, Miosis and slight ptosis appear in early stages and later on signs of third nerve palsy.
In addition patient exhibits tremors either on the same or opposite side of the body. Diminution of corncal reflex on the affected side is due to compression of fifth cranial nerve.
Occipital lobe tumors are not very common but produce signs of raised intracranial pressure in a conspicuous mannet
Epileptic convulsions preceded by visual aura are common. Characteristically patient has visual field defect (crossed homonymous hemianopia). Central vision usually escapes. Neighborhood symptoms (Auditory hallucinations with word deafness, impairment of taste and smell, sensory
impairment of cortical type and slight motor weakness) may be present. There is also nystagmus, hypotonia and in coordination as a result of pressure on cerebellum.
The tumors in this region are uncommon. Mental symptoms of brain tumor are prominent and are often the first to be noticed. Patient is apathetic, drowsy and has severe form of memory defect. Convulsions may occur.
Extension of tumor present in the midline may lead to bilateral pyramidal tract involvement (Double hemiplegia). If tumor is placed anteriorly it may produce grasp reflex on one or both sides. Apraxia, Tremors and chore form movements are present in few. Signs of increased intracranial pressure are late in appearing.
Severe paroxysmal headaches are important features of the third ventricle tumors. Hydrocephalus (acute, sub acute, intermittent, chronic) may be seen. Papilloedema is important sign. Progressive dementia may occur. Coma may develop suddenly.
Neighborhood symptoms include somnolence, polyuria, glycosuria, sexual regression and irregular fever. If the growth extends laterally to internal capsule signs of pyramidal defect appear on one or both sides.
Signs of raised intracranial tension like Headache vomiting and papilloedema are early symptoms. Since midbrain lesions usually cause internal hydroeephalus ocular abnormalities are common. There is paralysis of third on the side of lesion with hemiplegia on opposite side. Pupils are unequal and tend to be dilated. There is loss of reaction to light.
Signs of pyramidal tract involvement on both sides may be present. Tonic fits are common. Tremors, nystagmus and ataxia result due to injury to cerebellar tracts. Sensory changes due to damage to long ascending sensory paths may occur.
Pons and Medulla
Signs of increased intracranial pressure are slow to develop. Headache mainly occipital and vertigo are common presentations and these are increased by rotation of head. Diplopia may be the first symptom. Crossed paralysis is seen at an early stage. There is weakness of jaw and facial muscles on one side and soft palate, tongue and limbs on the other side.
There is sensory loss in the distribution of trigeminal nerve. Cranial nerve palsies are common.
Impairment of hearing may occur. Sensory changes may be unilateral or bilateral. Nystagmus and some degree of ataxia is present. Paralysis of ocular sympathetic on one or both sides is common and visceral functions of medulla may be involved.
It is a common site of tumor especially in children. The symptoms of brain tumor mainly pertain to cerebellar functions. There is ataxia, disturbances of posture, nystagmus, adiadokokinesia, explosive speech, tremors and muscular hypotonia.
Midline tumors common in children are characterized by symptoms of raised intracranial tension early (Headache, vomiting, papilloedema) Hydrocephalus in children produces symptoms of hypopituitarism. Symptoms of cerebellar deficiency are marked on standing. Nystagmus is uncommon. In tumors of lateral lobe signs of raised intracranial tension also occur early. Nystagmus is usually marked. Ataxia is present on the affected side. Hypotonia is prominent. Neighborhood symptoms include cranial nerve palsies and pyramidal tract defect on the opposite side of the body.
Treatment of Brain tumor
It shall depend on the nature and site of the growth. In a patient who develops focal neurological signs or evidence of stupor, treatment is directed towards reducing cerebral edema and lowering intracranial pressure (Glucocorticosteroids, hypertonic glucose, diuretics). Anti-convulsant medications (Phenytoin 100 mg there to four times a day) is prescribed if there are seizures.
Further treatment shall depend on investigating the nature of tumor. (CF scan, MRI and tumor biopsy. Resection (partial or complete) is attempted followed by chemotherapy and radiation. Prognosis shall vary on the nature of growth.
Check the video below on symptoms of brain tumor: