Brain tumours

Question 1

Be aware of the presenting features of brain tumours

Answer 1

• raised intracranial pressure
  
  • children/ adolescents
    
    • ​headache- worse in the morning
    • vomiting- on waking
    • behaviour/ personaility change
    • visual disturbance
    • papilloedema
  • infants
    
    • ​vomiting
    • seperation of sutures/ fontanelle tense
    • increased head circumferrence
    • head tilt/ posturing
    • developmental delay/ regression
• site dependent symptoms
  
  • ​supratentorial cortex: seizures, hemiplegia, focal neurological deficits
  • midline: visual field loss (bitemporal hemianopia), pituiatary failure (growth failure, diabetes insipidus, weight gain)
  • cerebellar/ 3rd/ 4th ventricle: truncal ataxia, co-ordination difficulties, abnormal eye movements
  • brainstem: CN signs, pyramidal tract signs, cerebellar signs (ataxia), often no sign of raised ICP
• spinal tumours (primary or metastatic)
  
  • ​back pain
  • peripheral weakness of arms, legs
  • bladder/ bowel dysfunction