Brain neoplasm

A space-occupying lesion (cerebral tumour, or a mimic such as subdural haematoma) raises intracranial pressure. Note that headache is an uncommon presenting symptom of a cerebral tumour — most present with focal deficits, seizures, or personality change.

Murtagh’s triad for raised ICP: vomiting + drowsiness + seizure.

Raised-ICP headache pattern

• Daily, worse in the morning for several hours; may be constant
• Generalised, often occipital, radiating behind the eyes; dull, deep, steady
• Aggravated by coughing, sneezing, straining (Valsalva)
• Vomiting, classically without preceding nausea
• Associated vertigo/dizziness, drowsiness, seizures, confusion

Examination

• Focal CNS signs
• Papilloedema

Tumour types by age

Two incidence peaks: <10 years and 35–60 years.

• Children (mostly infratentorial): medulloblastoma, posterior fossa astrocytoma, ependymoma, brainstem glioma
• Adults: cerebral glioma, meningioma, pituitary adenoma, cerebral metastases

Investigations

Imaging — MRI preferred; CT acceptable initially/for acute presentations.