Symptoms of a Brain Tumor

When a headache gets worse or won't go away, it's natural to wonder whether it could be a symptom of something more serious, like a brain tumor. While headaches can be a symptom of brain tumors, those that are truly tumor-related usually have distinct characteristics or are combined with other symptoms, such as vomiting. In fact, seizures are usually the first sign that a brain tumor might be present. Other symptoms can include cognitive changes, loss of consciousness, ​dizziness, and vomiting.

Brain tumors can be benign (non-cancerous) or malignant (cancerous). The symptoms of each are very similar. Symptoms may arise because of impairment of the particular area of the brain where a tumor is located or increased intracranial pressure, which is pressure in and around the brain.

For example, a tumor in the area of the brain that processes vision may result in double vision. A tumor in the area of the brain that controls balance may result in incoordination. Increased intracranial pressure can produce a range of symptoms that affect areas of the brain that are near the brain tumor, or areas of the brain that are located relatively far from the brain tumor.

The symptoms of a brain tumor may be very mild and subtle or severe and life-threatening. Keep in mind, however, that most of these symptoms are common to many other conditions.

Signs and symptoms of a brain tumor include: 

Seizures

Seizures are often the first symptom experienced when a brain tumor is present (not headaches, as many believe).

There are several different types of seizures, and those caused by brain tumors are focal seizures. They arise in the area occupied by the brain tumor and may rapidly spread to involve the whole brain. Generalized seizures, on the other hand, arise in the whole brain and are usually caused by congenital diseases; absence seizures are one example. While a simple observation usually isn't enough to determine that a seizure is a focal one, it is important in your diagnostic workup.

Tonic-clonic (grand mal) seizures can cause the body to shake all over in varying levels of intensity, and they typically begin as focal seizures in one area of the brain before quickly spreading within seconds to become generalized. There is usually loss of consciousness as well as loss of bladder and sometimes bowel control. Myoclonic seizures may cause bothersome muscle twitches, but without loss of consciousness.

Sensory seizures may result in changes in vision such as seeing flashing lights, a strange sense of smell, smacking lips, or other sensory symptoms. Some seizures may cause a person to sit still and stare into space, not seeing his surroundings. Yet other seizures may cause déjà vu-like experiences.

Headaches

Up to half of the people with brain tumors suffer from headaches. Brain tumor headaches tend to be dull and persistent, with throbbing headaches occurring less often. Headaches due to a brain tumor are often worse in the morning and may get better throughout the day. They may cause pain all over or that's worse on one side of the head. Additional symptoms, like vomiting, may (and most often are) also be present. Pain may also worsen with physical activity, sneezing, coughing, bending over, or bearing down while having a bowel movement. 

Vomiting

Vomiting, especially in the morning, with or without nausea, can be a symptom of a brain tumor. Vomiting is most common in the morning, and, when due to a brain tumor, is often triggered by an abrupt change (such as rolling over in bed).

Cognitive Changes
Brain tumors can affect many areas of cognition. It is important to keep in mind that these changes can be subtle, and a person who has a brain tumor may be able to keep his or her job or function socially, but something just might be a bit "off."

Cognitive changes caused by brain tumors include:

• Memory: A brain tumor may cause the brain to process information at a slower speed. A person may become forgetful in a way that at first isn't alarming, but progresses beyond the forgetfulness we all experience at times.
• Problem-solving: Tasks such as doing simple math, writing sentences, setting up a chess board, or even following a recipe may become challenging.
• Concentration: A person may become more easily distracted and have problems staying on task. It may take longer to complete basic tasks than usual.
• Confusion: Symptoms can vary from mild confusion, such as not understanding the nuances of a conversation, to more extreme symptoms, such as not recognizing the face of a familiar person.
• Spatial problems: Problems with spatial perception may cause clumsiness. A previously good driver may have a car accident due to changes in depth perception.

Loss of Consciousness
When intracranial pressure becomes very high, it can cause pressure on the brain itself. Loss of consciousness may occur for a few reasons. A person may become progressively more fatigued to the point of unconsciousness, or it may occur suddenly. Depending on the cause, loss of consciousness may progress to a coma. 

Personality or Mood Changes
Adults who have brain tumors sometimes experience personality changes. They may laugh at inappropriate times, have a sudden increased interest in sex, throw temper tantrums, become paranoid, or engage in risky behaviors. It's also possible for typical personality traits to become exaggerated. Symptoms of a brain tumor have also been known to mimic depression. 

Vision and Hearing Problems
Some brain tumors can cause visual or auditory disturbances. Problems with vision can include seeing flashing lights, double vision, blurring, and loss of vision. Auditory disturbances can include one-sided hearing loss and ringing in the ears. When a tumor involves the brainstem, the pupil in one eye may become dilated; this symptom should be considered an emergency.

Physical Changes
Brain tumors may cause weakness on one side of the body, as well as clumsiness, dizziness, loss of balance, or stumbling. An abnormal gait may also be present, and coordinated movements may become difficult. Difficulty in swallowing without an obvious cause may also be a symptom.

Speech Changes
Slurring of words or difficulty speaking clearly can occur. A person who has a brain tumor may have difficulty forming or finding words, say things that make very little sense, or not be able to understand what others are saying. 

Sometimes symptoms are very specific to where in the brain the tumor is located. These often overlap with the more frequent symptoms. 

Frontal Lobe Tumors

The frontal lobes are in the area of the brain where thinking and judgment take place. Tumors in this area can cause an intellectual decline as well as a change in personality. Due to pressure on the olfactory nerve, they may also result in a loss of the sense of smell (anosmia). The ability to speak (expressive aphasia) may also be impaired. 

Temporal Lobe Tumors

The temporal lobes are involved in speaking and hearing. Tumors in this area can result in auditory hallucinations (hearing things), an inability to understand speech (receptive aphasia), and vision changes. Symptoms such as deja vu experiences, depersonalization, and seeing things as either larger or smaller than they really are may also occur. Both frontal lobe and temporal lobe tumors may cause emotional changes, such as an increase in aggressiveness. 

Parietal Lobe Tumors 

The parietal lobes at the top of the brain can cause changes in sensation on the opposite side of the body. This area of the brain is also very important in coordinating different parts of the brain, and tumors may result in problems with orientation (like knowing up from down) as well as recognition. People with a tumor in this region may ignore one side of their body or experience spontaneous pain.

Occipital Lobe Tumors 

The occipital lobes at the back of the brain are involved in vision. Symptoms can vary from visual hallucinations to visual field defects (only seeing part of the world around them) to cortical blindness—vision loss despite a perfectly functioning eye.

Cerebellar Tumors

The cerebellum at the lower back of the brain is responsible for balance and coordination. Tumors in this region may cause incoordination similar to that associated with being drunk. These tumors also can cause difficulty with fine motor skills, such as writing or brushing teeth.

Brainstem Tumors

The brainstem is the relay station between the upper part of the brain and the rest of the body, and it also controls vital functions such as breathing and heart rate. Tumors in this area may cause numbness or weakness on the opposite side of the body from the tumor, double vision with uneven pupils, dizziness, droopy eyelids, and other symptoms. Loss of consciousness may also occur, and death is possible if the tumor is not recognized. Tumors in the upper regions of the brain may also affect the brainstem if they cause pressure resulting in brain tissue herniating (getting pushed) into the brainstem.

Pituitary Gland Tumors 

Tumors in the pituitary gland (such as a Craniopharyngioma) may result in changes in energy level, menstrual periods, lactation (production of milk), and growth of the hands and feet in an adult.

Signs and symptoms of brain tumors in children are often the same as those in adults. Some symptoms, however, are unique to children, including:

• A headache that awakens a child from sleep
• Not reaching age-appropriate developmental milestones
• Behavior changes (for example, a loud child may become quiet and vice versa)
• Turning his/her head in order to see something, as opposed to moving his or her eyes
• Vomiting, often projectile

In infants, the soft spot on the skull where the plates have not yet closed (fontanelle) may bulge, and the baby may become fussy when her head is touched. 

Complications are often associated with brain tumors that increase in size, but even a small tumor can have detrimental effects if it is near structures in the body that control vital functions. 

Complications of brain tumors include:

• Increased intracranial pressure: Because the skull is an enclosed, inflexible space, a brain tumor that increases in size can increase the pressure on other areas of the brain. As brain tissue is physically squeezed, it can lose function or be pushed down toward or into the upper spinal cord, depending on the location. When the latter, known as herniation, happens, it can cause dilated pupils, rapid breathing, an irregular heartbeat, and may cause death very quickly if not urgently treated. 
• Hydrocephalus: Often, a brain tumor obstructs the flow of fluid in the ventricles, the "open" regions of the brain through which fluid flows. When this occurs, intracranial pressure increases and symptoms of confusion, vision impairment, and loss of consciousness arise. Sometimes, the ventricular obstruction cannot be relieved, so fluid must be removed; often, a ventriculoperitoneal shunt must be placed.  
• Disruption of vital functions: When brain tumors affect the brainstem, they can interfere with breathing, heartbeat, and blood pressure, causing sudden, dangerous changes in these vital functions. This may cause a sudden emergency or even death. 

Once again, it's important to remember that symptoms of brain tumors overlap with those of many much less serious problems, and, most of the time, do not indicate a brain tumor. That said, finding a brain tumor early reduces the chance that it will cause further damage and that it can be treated successfully.

Call your doctor if you're having frequent headaches, cognitive problems, weakness, or visual or auditory problems. Your physician will tell you if you should go to the emergency room instead of waiting for a visit to his or her office.

That said, any severe or sudden symptoms warrant a call to 911 or a trip to the emergency room. They may not be due to a tumor but could be signs of other serious conditions, such as a stroke, an aneurysm, brain metastases from cancer, or a bleed into the brain.