Brain tumors may have a variety of symptoms ranging from headache to stroke. They are great mimics of other neurological disorders. It is sometimes hard to know whether a CT scan or MRI should be done if someone you know has some of the symptoms and signs noted below, but it is important to know that these studies will usually establish whether a brain tumor is behind them. The following symptoms immediately raise the question of a brain tumor:

• A new seizure in an adult.
• Gradual loss of movement or sensation in an arm or leg.
• Unsteadiness or imbalance, especially if it is associated with headache.
• Loss of vision in one or both eyes, especially if it is more peripheral vision loss.
• An eating disorder as a child.
• Double vision, especially if it is associated with headache.
• Hearing loss with or without dizziness.
• Speech difficulty of gradual onset.

The following symptoms are usually not the result of a brain tumor, but may sometimes be:

• Headache is probably the most common symptom of a brain tumor. Most people with headache, even persistent or severe headaches, do not have a tumor. However, some kinds of headache are particularly worrisome. A steady headache that is worse in the morning than the afternoon, a persistent headache that is associated with nausea or vomiting, or a headache accompanied by double vision, weakness, or numbness all suggest a possible tumor.

• A change in behavior may also be caused by a brain tumor. The development of an "I don't care" attitude, memory loss, loss of concentration, and general confusion may all be subtle signs: here, an evaluation by a neurologist may be an important step, but a CT or MRI will also help.

• Infertility or amenorrhea (abnormal cessation of menstruation).

• Some troubles which seem to be other diseases may in fact be a tumor: a stroke, even when it looks like one on a CT, may turn out to be the result of a tumor. Sometimes a fall can come from a seizure caused by a tumor. A pituitary tumor can present like a subarachnoid hemorrhage, a kind of stroke.

As you can see, the ways a brain tumor can show up are varied. If you are concerned, call a doctor who is familiar with these tumors. Early detection and treatment may increase survival - if symptoms persist, sometimes gentle urging for an MRI is important to assure that everything is all right.

Peter McL. Black, M.D., Ph.D.
Neurosurgeon-in-Chief
Brigham and Women's Hospital
and Children's Hospital
Boston, Massachusetts