Know it, to control it
Brain is contained in a hard bony cage called cranium, with a covering of dura, the tough layer that protects the brain during sudden impacts. Brain is composed of nerve cells, supporting cells, nerve fibers for communication of signals, blood vessels, however there are no lymphatics as are present elsewhere in the body. The tumors in brain can arise from any of its components and in most of the cases the tumors do not metastasize out of the cranium except for some childhood tumors that can travel into the spinal cord area. The symptoms of brain tumour are mainly due to the pressure effects of the tumour on surrounding normal brain structures.
To detect brain tumors a doctor has to have a high index of suspicion as the symptoms may be non-specific. If there is high index of suspicion an early diagnosis can be arrived at and right treatment can be provided.
Headaches: Headache is the commonest symptom of brain tumors and is reported in approximately 50% of patients. Headache may be more in the morning especially for tumour located over the nape of neck, back side of head. It may worsen with bending forwards. All headaches are not due to brain tumors; however if the headache is constant and persists beyond a few days to two weeks, it should be investigated thoroughly including having an MRI, if prescribed by the doctor.
Seizures: Epilepsy or fits is the second most common symptom and is reported by a third of patients. Epilepsy can be caused by many other conditions e.g. fever in young children, fall or trauma, stroke etc. After the first seizure the patient should be seen by the doctor and complete description of the body movements, up rolling of eyes, frothing at month, tongue bite etc along with the duration of complete fit should be given to the medical care giver. Seizures can occur even after the removal of tumors, hence doctors prescribe anti epileptic medicine after surgery for a long time. A patient on anti-epileptic medicines should not drive.
A seizure is a sudden, jerky movement of a part or whole of the body and may be preceded by an aura of smell, vision or hearing. It may be accompanied by loss of consciousness and/or fall. Temporal lobe epilepsy may result in a vacant stare or difficulty in speech.
Nausea and/vomiting: Intracranial tumors can cause nausea and/or vomiting due to rise in intra cranial pressure. This symptom is non-specific but has to be taken in support with history of headache and/or epilepsy. There may be other causes of nausea/vomiting e.g. gastritis or gastroenteritis.
Visual or hearing problems: Approximately 25% patients may present with visual or hearing impairment. An eye doctor can diagnose the rise in intra cranial pressure by fundus examination. Loss of hearing may be due to infection, trauma or age related, however, in young adults progressive decrease in hearing may be related to a brain tumour.
Weakness of arm/legs: A strange sensation in arms/legs or hands followed by muscle weakness or paralysis can indicate a brain tumour. This symptom can be present after a stroke or trauma and should not be ignored. Any patient with such a symptom should be taken to an emergency in a hospital and scanned.
Behavioral and cognitive problems: Patient may develop sudden loss of short term memory, inability to find right words while making speech, inappropriate behavior or become short tempered. These sudden changes in behavior can indicate a space occupying lesion and an MRI of the brain should be done.