Catching the pain

In recent times, brain tumours are being diagnosed more frequently, thanks to technological advancements and newer diagnostic modalities. These tumours exhibit symptoms mainly because of their locations, sizes and the fact that they are in a closed space. Commonly, brain tumours are classified in two types:

Benign- These are non-cancerous, slow growing and well-defined, and are not usually deeply rooted. These present symptoms when they attain bigger sizes and start compressing their surrounding areas. They usually do not recur.

Malignant- These are cancerous tumours that are rapidly growing and ill-defined. They present symptoms early in the course of the disease. They are known to recur and may need adjuvant chemotherapy or radiotherapy. These are some possible common symptoms of brain tumour:

Headache in the early morning hours is one of them. It may be severe, throbbing and located at both frontal regions. It is usually severe in the beginning and fades away as the day progresses. It may be associated with vomiting. This does not respond to usual painkillers.

Nausea and vomiting is another. The patient feels sick and develops nausea frequently.
Blurring of vision, loss of vision, diplopia (double vision), usually appears late.
Fits (seizures) are one of the most common symptoms of brain tumours. They appear in one in four people. A seizure can be jerking or twitching of a hand, arm or leg or may affect the whole body. Some fits just cause a moment of unconsciousness. And if your brain tumour is successfully treated, the fits may stop completely. Adults over 40 years of age having their first seizure need to be evaluated for brain tumours. These are some symptoms related to location of the tumour:

In the frontal lobe (it may take long time to be symptomatic)

Changes in personality (depression, rage, anti-social behaviour, impulsiveness)
Loss of inhibitions
Losing interest in life
Difficulty with planning and execution
Loss of recent memory
Weakness in part of the face, or on one side of the body
Difficulty in walking
Loss of sense of smell
Problems with sight or speech
Incontinence of urine

In the temporal lobe

Difficulty in naming objects, loss of comprehension
Difficulty finding the correct word
Short term memory loss
Fits associated with strange feelings, smells or déjà vu
Hearing voices in the head
Visual loss

 In the parietal lobe

Difficulty speaking or understanding what is said to you
Problems with reading or writing
Loss of feeling in part of the body
Inability to appreciate texture of different object
Right & left disorientation
Difficulty in writing and calculation

In the pituitary gland

Irregular or infrequent periods
Infertility in men and women
Lack of energy
Weight gain
Mood swings
blood pressure
Diabetes
Enlarged hands and feet

Some tumours can mimic acute stroke like glioblastoma, pituitary tumour and meningiomas, because of intratumoural bleed. Acoustic neuroma, which arises between the brain stem and cerebellum can cause facial pain resembling trigeminal neuralgia because of compression over trigeminal nerve. Pituitary tumour, craniopharyngiomas, meningiomas can present with blindness or visual field defects. Temporal tumours can present as seizures of typical nature characterised by sense of abnormal smell, sudden loud cry, followed by abnormal movements.

It is important to remember that there are many other causes for the symptoms mentioned above. If you are worried, you need to go to a doctor. They will send you to a specialist if they think there is any possibility that you could have a brain tumour. Sometimes, tumours in the frontal or temporal lobes of the cerebrum can become quite large with very few symptoms. In the elderly, vague symptoms of memory loss, personality changes and difficulty in walking can be put down to getting older. If several symptoms like these develop over less than six months, it is worth checking with your doctor.

(The author is neurosurgeon, Narayana Multispecialty Hospital, Bengaluru)