Brain Tumour: The Early Signs That Get Missed

Almost everyone who searches this is worried about a headache. So the useful place to start is with reassurance that is actually true: headache alone is rarely a brain tumour. Tension headaches, migraines, sinus problems, eye strain, dehydration and blood pressure account for the overwhelming majority of what we see.

But some presentations do warrant a scan, and the difference is about pattern rather than severity. A really painful headache is not necessarily worrying. A mild one that has changed character over three weeks might be.

Which headaches are worth investigating?

• New, and progressively worsening over days or weeks — the single most important pattern
• Worse in the early morning, or on lying flat, easing after being upright a while
• Wakes you from sleep
• Worse on coughing, straining or bending forward
• Accompanied by vomiting, particularly without nausea beforehand
• Different from any headache you have had before, in someone who gets headaches

A headache that has been the same for five years is not the one to worry about.

The signs that are not headaches

These matter more than head pain, and are more often missed because they arrive gradually:

A first seizure in an adult. Always needs imaging. Many causes, most not tumours — but never dismiss it.

Vision changes. Blurring, double vision, or losing awareness of things to one side. People often visit an optician first, which is reasonable, but persistent unexplained change needs a neurological opinion.

One-sided weakness or numbness in a face, arm or leg, developing over days or weeks rather than suddenly. Sudden onset is more likely a stroke and is an emergency. Weakness confined to one leg, with pain running down it, is far more often a spine or nerve problem than anything in the head.

Speech difficulty — losing words, or slurring.

Personality or memory change. This is the classic missed sign, because the patient rarely notices it. Family members do: someone becomes uncharacteristically irritable, apathetic, or forgetful over a few months. When a relative says “he has not been himself since around Diwali”, that is clinical information worth taking seriously.

Loss of balance or coordination, unexplained by anything else.

Hearing loss on one side, or persistent one-sided ringing.

What if it is sudden?

Go to an emergency department immediately, not a clinic, for:

• The worst headache of your life, arriving in seconds
• Headache with fever and a stiff neck
• Sudden weakness, facial droop or speech loss
• A seizure lasting more than five minutes, or repeated seizures
• Head injury followed by increasing drowsiness or confusion

Sudden severe symptoms suggest bleeding or stroke, which are time-critical in a way that a tumour is not.

What does assessment involve?

A neurological examination first — power, sensation, reflexes, coordination, vision fields, and the back of the eye, where raised pressure inside the skull often shows itself before anything appears on a scan.

If imaging is warranted, MRI with contrast is the definitive test. CT is faster and is what emergency departments use, but it can miss smaller lesions and those near the skull base, so a normal CT with continuing symptoms is not the end of the enquiry.

Are they all cancer?

No, and this is worth stating plainly because the word “tumour” does a lot of frightening work.

Many are benign — meningiomas and pituitary adenomas among the commonest. Benign means it will not spread elsewhere in the body. It does not mean harmless: the skull is a fixed space, so even a slow-growing benign tumour can press on something important. But the treatment and the outlook are entirely different from a malignant tumour, and many benign ones are simply monitored.

Some brain tumours are secondary — spread from a cancer elsewhere, most often lung or breast. That changes the whole approach, which is why the assessment looks beyond the head.

Treatment, in outline

Depends on type, size, location, your age and your symptoms:

• Observation with periodic scans, for small benign incidental findings
• Surgery — to remove it entirely where possible, or to take a biopsy and relieve pressure
• Radiotherapy, including focused stereotactic radiosurgery
• Chemotherapy, for certain malignant types
• Medication — steroids to reduce swelling, anti-seizure drugs where needed

When to see a neurosurgeon in Uppal

Book an appointment if you have a headache matching the patterns above, a first seizure, unexplained neurological changes, or a scan report you do not understand. Also come if a family member has noticed a change in you that you cannot account for — that observation is often the most reliable evidence in the room.

Dr. Srinivas Thankari consults in neurosurgery at UNO Super Speciality Clinics, Uppal, Monday to Saturday, 6–9 PM. Bring any scans, films and reports you already have.

Most people who come in worried about a brain tumour do not have one. Getting that answered properly is a good reason to come, not a waste of anyone’s time.