By: Gregg Lowery, OMS-IV, Pacific Northwest University of Health Sciences, College of Osteopathic Medicine

Suppose someone randomly approached you and asked, “What are the symptoms of a heart attack and stroke?” Given the number of public ads informing you of the respective symptoms for both you’d likely be able to list most, if not all, of them. What if someone were to ask you the same question about brain tumors? Would you feel as confident answering this question?

Fortunately, brain tumors are not very common with an estimated occurrence of 30 out of every 100,000 people in the United States. With exposure to radiation being the only established risk factor, most primary tumors arise sporadically. This is especially true in tumors that develop in young adults. Once past the 30-40 age range, metastatic brain tumors unfortunately become more common. To clarify, a primary tumor describes a tumor that developed at the anatomical site it is located. A metastatic tumor describes a tumor that developed and spread from a different location of the body.

The type of lesion may influence how long it takes for an individual to detect or display symptoms. For malignant or metastatic tumors, symptoms may progress over a shorter period of days to weeks. In contrast, benign tumors may take weeks, months, or possibly even years before individuals become symptomatic. Some with benign brain tumors may even remain asymptomatic (no symptoms at all) with a mass being detected by imaging ordered for other reasons. So what exactly are some signs of a brain tumor?

Many would guess that headaches are a common sign of a developing tumor. While half of those with brain tumors report headache, headaches in general are usually not due to a tumor. Headaches that are associated with tumors tend to progress in severity over time. These headaches will also tend to present without a certain pattern, meaning they don’t routinely occur at specific times during the day nor do they seem to be aggravated by certain activities.

In contrast to headaches, seizures are one of the most common symptoms experienced in those with either a primary or metastatic tumor. These seizures tend to be focal meaning that the clinical signs expressed depend on the location of the tumor itself. For example, a tumor residing in the frontal lobe of the brain may produce stiffening and rhythmic jerking of a particular extremity. However, multiple consecutive seizures without a period of consciousness (called status epilepticus) can also be a clinical manifestation of brain tumors.

In addition to focal seizures, other focal signs may occur based on the location of the tumor. Muscle weakness of a particular extremity can be a subtle but common complaint. Sensory impairment such as changes in balance, coordination or vision can be a result of brain tumors. Difficulties with understanding speech and producing comprehensible language may develop.

So when your doctor asks you to push their hands away or squeeze their fingers realize they are not checking to see if you really have been going to the gym. If they ask you to open wide and move your tongue side to side, they really are checking cranial nerve function and not signs that you actually have been eating salads regularly. Thankfully brain tumors are not extremely common among the population. However, as with many medical conditions, earlier detection leads to earlier treatment and usually a better prognosis. Knowing the signs can be the first step in deciding whether to talk to your healthcare provider.

References:
Wong, ET and Wu JK. (2018) Overview of the clinical features and diagnosis of brain tumors. Eichler AF (Ed.) UpToDate. Retrieved March 22nd, 2019 from https://www-uptodate-com.proxy.pnwu.org/contents/overview-of-the-clinical-features-and-diagnosis-of-brain-tumors-in-adults