A young man presented with severe persistent headache. After receiving many pain killers, when the pain persisted, he was sent for further investigations and a brain tumor was detected. Brain tumors like tumor elsewhere occur due to abnormal cell proliferation in the brain. But they differ from other types of tumors in their clinical features and sequel. 

Some of these tumors are present since birth. Radiation, constant use of mobile phones, exposure to radiation in any form, immune deficiency, hereditary factors, tobacco and alcohol use are some of the suspected risk factors leading to development of brain tumors. People who are exposed to chemicals like formaldehyde, vinyl chloride, are at high risk of developing brain tumor.

The tumor may be located in the brain substance or in the coverings of the brain like meningiomas. Lymphomas develop in the lymphatic substance of the brain. Cancers from elsewhere in the body like breast, thyroid, stomach, lungs, e.t.c. can also spread to brain. But tumors from the brain usually do not spread to other parts of the body. Coverings of the brain and the blood brain barrier prevent spread of these tumors to rest of the body.

These tumors can occur at any age but are more common in young children below 8 years or elderly people.

Men and white people are more prone to brain tumors as per statistics. Some tumors have greater predilection for particular ages. For example, acoustic neuromas tend to occur more in young adults. Low grade gliomas, ependymomas, teratomas are basically brain tumors of children.

Typical symptoms of brain tumor occur because of growth of the tumor in a closed space. There is throbbing headache over the site affected which is more in the morning. This headache increases in duration and severity as the tumor grows. It is associated with vomiting without nausea. Pain on exposure to light, can also be present.

Convulsions can occur if there is irritation of the brain substance by the tumor. Paralysis of one or more limbs, loss of vision or hearing may develop depending on the location of the tumor. There may just be a vague dull headache, thus making suspicion and diagnosis of a tumor difficult.Subtle change in behavior, forgetfulness, mild visual disturbances, etc. are atypical features which mimic many other conditions and delay diagnosis of a brain tumor. Once started, the tumor can spread to other parts of the brain causing further damage.

Onset of convulsions in adults, occurrence of migraine in a person above 40 years, unexplained headache or loss of consciousness, onset of unexplained depression in elderly person, should alert one to the possibility of brain tumors.

Diagnosis is often delayed as the symptoms develop when the tumor is fairly well developed. It is made by computed tomography and other imaging techniques. A brain tumor can be benign or malignant, which is determined by biopsy. Both have potential to cause neurological damage.

Usually a tumor which is benign and or has not spread to adjacent organs is operated upon. The operation itself needs surgery in skilled hands as there is a high risk of damage to the brain substance during surgery.

Chemotherapy and radiotherapy are other treatment options used. All these are associated with unpleasant sequel. For example chemotherapy usually causes loss of hair which is very uncomfortable for the sufferer.

Therefore even if there is a doubt, a person should undergo all tests possible to exclude a brain tumor. Once diagnosed, both the family and the patient need a lot of counseling and reassurance. They have to be explained that brain tumor usually does not kill a person but troubles by causing neurological problems.

Dr Rachna Pande  is a specialist in internal medicine at Ruhengeri Hospital