Differential Diagnosis (Continued)

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

Infections (abscesses) can mimic a brain tumour with confusing symptoms: headache, seizures, disorientation, unilateral weakness and, usually, fever. 

Vascular lesions may be the first sign of a glioma by acute bleeding into or in the vicinity of the tumour, causing a neurological deficit. Stroke can also imitate a primary brain tumour.

In the parasellar region, one should always consider the possibility of an aneurysm.

Epileptic manifestations can sometimes be misinterpreted and delay tumour diagnosis. The clinician should therefore be aware of the possibility of a brain tumour, regardless of the type of underlying epileptic seizure.

Epileptic aura could be indicated by a sudden transient dysphasia in the absence of other symptoms, transient focal deficiency symptoms (numbness and paresis), sudden emotional, autonomic or hallucinatory symptoms.

Contrast enhancement on CT or MRI does not always differentiate low-grade glioma from non-tumour causes. Characteristics on MRI/CT (calcifications, fat, signal intensity) may be a clue to diagnosis.

Affective disorders may be due to causes other than glioma, e.g. side effects of any treatment given, or occur as a reaction to other aspects of life, including adjustment to a brain tumour diagnosis.

Excessive anxiety of having a tumour in the brain is not uncommon in patients with severe headache.

Although chronic headache very rarely leads to the detection of a brain tumour, in some explicit cases it can be an indication for a CT/MRl to alleviate the patient’s concerns.

Revision Questions

  1. What are the symptoms of an intracranial abscess?
  2. Give examples of epileptic auras that can be a sign of tumour.
  3. What about affective disorders and glioma?

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Last update: 18 September 2017