Signs and Symptoms of Nervous System Tumors
A tumor is a mass of cells that grows over time and expands inside the brain. This expansion causes two general types of symptoms: increased pressure inside the head (intracranial pressure) and disrupted brain function. The increased intracranial pressure can result from the growing tumor itself, from swelling associated with metastatic tumors, or from hydrocephalus (swelling caused by the accumulation of cerebrospinal fluid) that obstructs the normal flow of cerebral spinal fluid (CSF).
Common nervous system tumor symptoms include headache, nausea and vomiting, general confusion and lethargy. When function of the brain is disrupted by localized problems associated with a tumor, symptoms include seizures, speech and language problems, visual problems, and general weakness. The location of the tumor often determines which particular symptoms occur.
In patients with nervous system tumors, various symptoms of neurological dysfunction occur no matter how slowly or quickly the tumor grows. In slow-growing tumors, however, the brain can sometimes accommodate for the growth of the tumor, and the symptoms may be less pronounced. When the tumor grows rapidly, the symptoms may occur very suddenly and intensely. The most common symptoms of a brain tumors include particular kinds of headache, seizures (especially in adults who have never experienced seizures before), nausea and vomiting (especially with other symptoms), a change in cognitive abilities (ability to perceive, reason and remember), and a wide range of neurological abnormalities, depending on where in the brain the tumor is located.
A new pattern or type of headache is the first noticeable symptom for about 20% of all people with brain tumors. Eventually, headaches will occur in over 60% to 70% of all patients at some point in the course of their illness. The headache often is on the same side of the tumor, but may occur anywhere on the head. Many headaches associated with brain tumors are located in the frontal areas of the head (e.g., forehead, top of head). This happens not because of the location of the tumor, but because the pain is referred to that area of the head. Referred pain is pain that is felt somewhere different from where it originates.
Headaches caused by brain tumors are usually do not throb and are worse in the morning after laying flat all night, because pressure in the brain increases when the head is down. They may be worse with exertion. Most patients experience nausea and vomiting with the headache. If the tumor is obstructing the ventricles (structures that contain the cerebrospinal fluid), the headache may get worse when the patient changes position.
A seizure is a sudden, brief attack of uncontrolled motor activity or altered consciousness. Seizures occur in approximately 35% of all brain tumor patients. The probability of having a seizure depends on the location of the tumor, as some parts of the brain are more prone to seizure activity than others. Some seizures may be partial, and involve only a single site in the brain. Others can affect the whole brain and result in loss of consciousness.
When a person develops a new pattern of headaches in the morning coupled with vomiting, a brain tumor should be ruled out. Even if this particular pattern doesn't develop, many people with brain tumors eventually develop chronic nausea and loss of appetite, which are presumably associated with the increased intracranial pressure (pressure within the skull compartment).
Patients with NS tumors often develop early changes in their cognitive abilities. These changes include difficulties remembering things, changes in personality or mood, lack of initiative, and poor judgement. Depending on where the tumor is located, a person may have reading, writing or speaking difficulties. It may be very difficult for some folks to engage in abstract reasoning, and some people may not be able to make decisions. Many people with brain tumors suffer from sleep disorders and restlessness and are unable to concentrate.
Specific neurological abnormalities caused by brain tumors vary from patient to patient and depend on the location of the tumor. For example, if the tumor invades the motor regions of the brain (areas responsible for movement of the skeletal muscles, such as those in the arms and legs), patients can experience motor weakness on the opposite side of the body (one side of the brain controls the opposite side of the body). In these patients, the arms and legs on the opposite side of the body may be stiff or move awkwardly.
When the areas of the brain responsible for sensing the environment (called the sensory structures) are damaged by a tumor, the patient may feel tingling, numbness, or other odd sensations. Some patients are not able to recognize parts of their environment. For example, if the tumor obstructs the visual pathways, in addition to vision loss, patients may not be able to recognize objects by looking at them. If the tumor is in the temporal lobe of the brain, a person may see hallucinations or experience other unusual perceptions. If the tumor is in the frontal lobe, a patient may have bowel and bladder problems.