Clinical presentation and diagnosis of brain tumors
- Eric T Wong, MD
Eric T Wong, MD
- Associate Professor of Neurology
- Harvard Medical School
- Julian K Wu, MD
Julian K Wu, MD
- Professor of Neurosurgery
- Tufts University School of Medicine
- Section Editors
- Jay S Loeffler, MD
Jay S Loeffler, MD
- Section Editor — Neurooncology
- Professor of Radiation Oncology
- Harvard Medical School
- Patrick Y Wen, MD
Patrick Y Wen, MD
- Section Editor — Neurooncology
- Professor of Neurology
- Harvard Medical School
Brain tumors are a diverse group of neoplasms arising from different cells within the central nervous system (CNS) or from systemic tumors that have metastasized to the CNS. Brain tumors include a number of histologic types with markedly different tumor growth rates (table 1 and table 2). (See "Classification and pathologic diagnosis of gliomas" and "Epidemiology, clinical manifestations, and diagnosis of brain metastases".)
Brain tumors can produce symptoms and signs by local brain invasion, compression of adjacent structures, and increased intracranial pressure (ICP). In addition to the histology of the tumor, the clinical manifestations are determined by the function of the involved areas of the brain. The proper evaluation of the patient with a suspected brain tumor requires a detailed history, comprehensive neurologic examination, and appropriate diagnostic neuroimaging studies .
The clinical manifestations and diagnosis of primary brain tumors will be reviewed here. Aspects of the various primary brain tumors are discussed in the specific topics, and the presentation and approach to patients with brain metastases is presented separately. (See "Epidemiology, clinical manifestations, and diagnosis of brain metastases".)
Patients with primary or metastatic brain tumors may present with either generalized or focal signs and/or symptoms (table 3).
Headaches — Headache is a common manifestation of brain tumors and is the worst symptom in about one-half of patients . The headaches are usually dull and constant, but occasionally throbbing. Severe headaches are infrequent, unless obstructive hydrocephalus or meningeal irritation is present. The "classic" early morning brain tumor headache appears to be uncommon. (See "Evaluation of headache in adults".)
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- CLINICAL MANIFESTATIONS
- - Headaches
- - Seizures
- - Nausea and vomiting
- - Syncope
- - Cognitive dysfunction
- - Weakness
- - Sensory loss
- - Aphasia
- - Visual spatial dysfunction
- DIAGNOSTIC NEUROIMAGING
- Magnetic resonance imaging
- Magnetic resonance spectroscopy
- Diffusion weighted imaging
- Diffusion tensor imaging (tractography)
- Perfusion MRI
- Functional MRI
- Computed tomography
- PET scans
- SPECT imaging
- DIAGNOSTIC NEUROSURGICAL INTERVENTION
- Preoperative assessment
- Surgical exploration or biopsy
- - Glial tumors
- - CNS lymphomas
- - Brain metastases
- INFORMATION FOR PATIENTS