🧠 Brain tumours can be primary (arising in the brain) or secondary (metastatic from other cancers). Symptoms reflect both the local effects of the lesion and raised intracranial pressure (ICP). Diagnosis relies on neuroimaging and histological confirmation by biopsy.

🔎 About

Primary tumours arise from glial cells, neurons, or meningeal tissue.
Secondary tumours commonly spread from lung, breast, kidney, thyroid, testes, or melanoma.
Neuroimaging (MRI/CT) is essential, biopsy gives definitive diagnosis.

🧬 Types of Brain Tumour

Primary: Gliomas (astrocytomas, oligodendrogliomas, glioblastomas), meningiomas.
Secondary (metastatic): From lung, breast, colorectal, kidney, testis, melanoma.
HIV-related: Primary CNS lymphoma (B-cell type).

🧾 Clinical Presentation

Headache (classically worse in the morning, with straining/coughing).
Seizures, personality/behaviour change, stroke-like deficits, coma.
Raised ICP → nausea, papilloedema, visual disturbance.

📍 Localising Features

Olfactory groove tumour: Anosmia, disinhibition, personality change.
Cavernous sinus tumour: Ophthalmoplegia (CN III, IV, VI, V1, V2 involvement).
Foster Kennedy syndrome: Ipsilateral optic atrophy + contralateral papilloedema (often olfactory groove meningioma).
Pituitary adenoma: Hypopituitarism, headache, bitemporal hemianopia.
Pineal region tumour: Parinaud’s syndrome (loss of upward gaze).

🧪 Investigations

Bloods: FBC, U&E, LFT, ESR/CRP, ± HIV testing.
CXR: To exclude primary lung cancer.
Tumour markers: AFP, CEA, CA125, PSA, S-100 depending on suspicion.
Imaging:
- CT head with contrast – tumour enhancement due to BBB breakdown.
- MRI with gadolinium – superior for staging and characterisation.
Biopsy: Required for histology and guiding treatment.

🖼️ Example Imaging

Suspected stroke on Day 1 → improved and discharged.

Worsening on Day 15.

Day 21: Tumour confirmed with contrast MRI.

💊 Management

Surgery: For histology, debulking, or relieving hydrocephalus.
Chemotherapy: e.g. temozolomide for gliomas.
Radiotherapy: External beam (e.g. medulloblastoma, CNS lymphoma); stereotactic radiosurgery for small meningiomas.
Supportive:
- Anticonvulsants for seizure prophylaxis.
- Dexamethasone for cerebral oedema.
- Neuro-oncology MDT for holistic planning.
- Palliative care in advanced/inoperable cases.

📚 References

Makindo Imaging Resources

💡 Exam Pearl: Suspect tumour if “stroke” symptoms evolve over days/weeks, or with features like morning headache, seizures, and progressive personality change.

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Brain Tumours