Brain Tumours

Most brain tumours are metastatic cancers from extra-cranial primaries. The commonest are:

• Lung
• Breast
• Kidney
• Melanoma

In consequence, they are most commonly seen in people over 50 years of age. Primary brain tumours are usually seen in patients under 50 years of age. The associated headache occurs by one of three mechanisms:

• Meningeal involvement
• Vascular involvement
• Raised intra-cranial pressure (ICP)

Presentation

Headache is a presenting feature in about 50% of patients with brain tumours. Seizures occur in 25% of cases, but are more common in patients with gliomas.

The classic headache associated with raised intra-cranial pressure is maximal on wakening and eases during the course of the day. The headache may wake the patient from sleep, and the headache is exacerbated by bending or straining.

Friends or relatives often describe personality changes and cognitive deficits.

On examination, weakness or focal deficits are identified in two-thirds of patients.