History and exam

Key diagnostic factors

common

presence of risk factors

Risk factors for gliomas include male sex; white ancestry; history of neurofibromatosis type 1, tuberous sclerosis, Li-Fraumeni syndrome, or Turcot's cancer syndrome; or history of exposure to ionising radiation.

Other diagnostic factors

common

altered mental status

Reported to occur in approximately 50% of patients presenting in the emergency department with a brain tumour.[25][31]

headache

Reported to occur in approximately 60% of patients with brain tumours.[32][33]

Unilateral headache indicates the side of the lesion in approximately 80%.

Tends to be worse with coughing, with the Valsalva manoeuvre, or when the patient is supine.[20]

nausea and/or vomiting

Reported to occur in approximately 50% of patients presenting in the emergency department with a brain tumour.[31]

gait abnormality

Reported to occur in approximately 41% of patients presenting in the emergency department with a brain tumour.[31]

ataxia

Reported to occur in approximately 37% of patients presenting in the emergency department with a brain tumour.[31]

Associated with cerebellar lesions.

weakness

Reported to occur in approximately 27% of patients presenting in the emergency department with a brain tumour.[31]

Associated with lesion in contralateral posterior frontal lobe or anywhere in the descending corticospinal tract.

seizures

Frequency ranges from 80% in patients with low-grade disease to 29% in patients with grade 4 astrocytoma.[25]

Associated with lesion in close relation to cerebral cortex. The type of seizure depends on the location of the tumour.

visual disturbances

Reported to occur in approximately 23% of patients presenting in the emergency department with a brain tumour.[31]

May present as diplopia (cranial nerve palsy), visual field cut (cortical lesion in temporal, parietal, or occipital lobe), or loss of acuity (lesion in optic-hypothalamic region).

speech deficit

Reported to occur in approximately 21% of patients presenting in the emergency department with a brain tumour.[31]

Associated with lesion in dominant posterior temporal lobe or antero-lateral frontal lobe.

aphasia/dysphasia

Reported to occur in approximately 12% of patients presenting in the emergency department with a brain tumour.[31]

Found in 37% to 58% of patients with left-sided tumours.[34]

Associated with lesion in dominant posterior temporal lobe or antero-lateral frontal lobe.

sensory deficit

Reported to occur in approximately 19% of patients presenting in the emergency department with a brain tumour.[31]

Associated with lesion in contralateral anterior parietal lobe or ascending sensory pathway.

motor weakness

Reported to occur in approximately 37% of patients presenting in the emergency department with a brain tumour.[31]

Associated with lesion in contralateral posterior frontal lobe or anywhere in the descending corticospinal tract.

visual change

Reported to occur in approximately 20% of patients presenting in the emergency department with a brain tumour.[31]

May present as diplopia (cranial nerve palsy), visual field cut (cortical lesion in temporal, parietal, or occipital lobe), or loss of acuity (lesion in optic-hypothalamic region).

cranial nerve palsy

Reported to occur in approximately 26% of patients presenting in the emergency department with a brain tumour.[31]

Sixth (VI) nerve palsy as a consequence of intracranial hypertension or direct invasion of third (III), fourth (IV), or sixth (VI) cranial nerve nucleus by brainstem lesion.

papilloedema

Reported to occur in approximately 28% of patients presenting in the emergency department with a brain tumour.[31]

More common in patients with a posterior fossa tumour.

uncommon

personality change/emotional lability

Personality change has been reported in 16% to 34% of patients, and is associated with large and/or bilateral frontal lobe astrocytomas.[32]

Emotional lability is associated with large frontal lobe lesions.

Risk factors

weak

white ancestry

In the US, gliomas are more common in white people than in people of any other racial group.[3][4]

male sex

Glioma occurs more commonly in males than in females; glioblastoma incidence rate is 1.6-fold higher in men than in women.[3][4]

neurofibromatosis type 1

Approximately 15% of children with neurofibromatosis type 1 develop optic nerve pilocytic gliomas.[5] These tumours are usually diagnosed during childhood and rarely progress after diagnosis.[12]

tuberous sclerosis complex

Approximately 10% to 20% of people with tuberous sclerosis complex develop subependymal giant cell astrocytoma (thought to be unique to this syndrome).[13]

Li-Fraumeni syndrome

Associated with diffuse astrocytoma and glioblastoma.[14]

Turcot's cancer syndrome

Associated with increased risk of developing glioblastoma. Relative risk of primary brain tumour is increased by a factor of 7.[15]

ionising radiation

Associated with malignant glioma. The mechanism is related to radiation-induced DNA strand breaks and mutation.[9] Patients with a history of therapeutic radiation to the head are at increased risk of developing a glioblastoma later in life.[10][11]

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