Clinical Presentation

Chapter 2 - Clinical Presentation, Differential Diagnosis and Response Assessment of Gliomas

The most common symptoms of brain tumours are headache, epileptic seizures, focal deficiency symptoms and/or more diffuse mental or thought-compulsive symptoms.

With acute symptoms pointing to incipient obstruction of cerebrospinal fluid (CSF) flow<\strong> (e.g. severe headache, disorientation, unilaterally dilated light rigid pupils), urgent contact<\strong> with a neurosurgeon is needed.<\p>

Suspicion of a primary brain tumour<\strong> should occur when at least one of the five criteria<\strong> in the table are met.


Patients may present with generalised symptoms of increased intracranial pressure (headaches, nausea and cognitive impairment) or signs that reflect the location of the tumour.

Headache, rarely alone as initial symptom, can vary in intensity and quality. It is frequently more severe on awakening, due to pain-sensitive meninges and blood vessels.

Psychiatric symptoms, e.g. anxiety and depression, seem to be underdiagnosed. Tumours in less critical areas (anterior frontal or temporal lobe) may be associated with subtle personality changes and memory problems.

Weakness and sensory hemineglect (more prominent in right hemispheric lesions) are the hallmarks of tumours arising in the frontal or parietal lobes and thalamic region.

Seizures of varying patterns (partial or generalised) are a common presentation of tumours in the frontoparietal regions and temporal lobe and are more often reported in low-grade glioma.

Occipital lobe tumours may present with slow onset of visual field defects. Bilateral crossed neurological deficits (weakness on one side with contralateral cranial nerve palsy) can be an initial indicator of brainstem glioma.

Revision Questions

  1. What are the alarm symptoms of a brain tumour?
  2. What is important to consider when analysing a patient with a potential brain tumour?
  3. Give one example of symptoms reflecting the location of the tumour.

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Last update: 18 September 2017