Clinical Features

The commonest symptoms of brain tumours irrespective of primary location are

• Headache
• Fits
• Specific, focal or localised neurological deficits (detailed below)

Brain tumours may cause raised intracranial pressure – this means that the circulation of the fluid that circulates around the brain and spinal cord – the cerebrospinal fluid or ‘CSF’ - is blocked. The fluid builds up and excess pressure causes a pattern of symptoms including:

• Headache – may be severe, worse in the morning and on coughing and sneezing
• Nausea and vomiting
• Drowsiness
• Blurred vision and blindness – raised pressure causes damage at the back of the eye. When there is swelling at the back of the eye this can be seen when the eye is examined with an ophthalmoscope - the characteristic appearance is called ‘papilloedema’.To consider H/R Mobility Severely Visually Impaired (SVI) criteria, see H/R Mobility Severely Visually Impaired (SVI) deeming provisions

Without adequate treatment raised intracranial pressure causes death within a short period. In addition to general symptoms there may be other symptoms that relate to where the tumour is in the brain. The following list relates only to general considerations and is not exclusive or specific for any given patient.

The brain is divided into lobes as illustrated below. The right side of the brain seen from the side, note the names and locations of the different lobes. This picture has been reproduced from this website: <a href=">http://sciencealive.wikispaces.com/Human+Brain under Creative Commons Attribution Share-Alike 2.5 License

Symptoms of brain tumours affecting the frontal lobe

The frontal lobes determine personality and contain the area called the motor cortex that controls movement of the muscles of the body (the motor cortex on the right half of the brain controls the left side of the body and vice versa). The frontal lobes are thought to be the area of the brain most involved in conscious thinking. Symptoms of tumours affecting the frontal lobe can include:

• Personality change
• Disinhibition – loss of inhibition leading to offensive behaviour which is out of character for that person e.g. swearing, rudeness, inappropriate sexual behaviour
• Irritability
• Aggression
• Apathy – loss of interest in life
• Difficulty planning or organising
• Weakness of one side of the face or body
• Problems walking
• Difficulty speaking

Symptoms of brain tumours affecting the parietal lobe

The parietal lobe contains areas responsible for the sensation of touch and association, this area enables fine judgement of sensation such as texture, weight, size. Symptoms of tumours in this area include:

• Loss of sensation in part of the body
• Sensory or motor neglect – e.g. a person with right sided sensory neglect will not respond to a sound from the right, gesturing by someone standing on their right or a touch to the right side of the body. They will respond normally to these stimuli on the left side.
• Difficulty speaking or understanding speech
• Problems with reading and/or writing

Symptoms of brain tumours affecting the temporal lobe

The temporal lobe has many functions including processing of audio and visual information, comprehension and memory of verbal information. Symptoms of tumours in this area include:

• Fits – these may be called ‘temporal lobe epilepsy’ this type of epilepsy is often associated with weird feelings, smells or dÉjÀ vu sensations which accompany or precede a fit.
• Short term memory problems
• Inability to recall words

Symptoms of brain tumours affecting the occipital lobe

This area is responsible for vision; symptoms include problems with or loss of vision on one side. Blindness that is caused by damage to the visual area of the brain is called ‘central’ or ‘cortical’ blindness.

Symptoms of brain tumours affecting the cerebellum

The cerebellum helps to coordinate balance, symptoms of tumours affecting the cerebellum include:

• Problems with balance and coordination
• Problems with co-ordination of limbs
• Intention tremor
• Abnormal eye movements – ‘nystagmus’
• Nausea and dizziness

Symptoms of brain tumours affecting the pituitary gland

The pituitary gland is a small gland inside the brain that produces many hormones that control and regulate processes in the body such as growth, production of sex hormones and thyroid function. Symptoms of these tumours may arise because too much hormone is produced – ‘functioning’ tumours or because the tumour interferes with the normal production of hormones (non-functioning) or compresses important parts of the brain located next to the pituitary gland. Symptoms may include:

• Loss of energy
• Menstrual irregularity in women
• Infertility in men and women
• Weight gain
• Mood swings
• High blood pressure
• Diabetes
• Enlarged hands and feet and changes in facial appearance
• Loss of visual fields

• Tests used for Brain Tumours

Amended April 2011