What are the signs of glioma (brain tumor)?

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Signs and Symptoms of Glioma

Gliomas present with symptoms that depend primarily on tumor location, size, and rate of growth, with the most common manifestations being headaches that worsen over time, seizures, and focal neurological deficits specific to the affected brain region. 1

Primary Clinical Presentations

Symptoms of Increased Intracranial Pressure

The most frequent presenting symptoms result from elevated intracranial pressure and include: 1

  • Headaches that progressively worsen over time (present in approximately 50% of patients) 1, 2
  • Nausea and vomiting 1
  • Blurred vision 1

These symptoms occur due to tumor growth, cerebral edema, or obstruction of cerebrospinal fluid flow. 1

Seizures

  • Seizures occur in 20-50% of patients and may be the initial presenting symptom in up to one-third of cases 1, 3, 2
  • Seizures are particularly common with certain low-grade gliomas due to tumor histology and peritumoral factors including regional hypoxia, ionic changes, and extracellular glutamate accumulation causing neuronal hyperexcitability 4

Focal Neurological Deficits

Location-specific symptoms occur in 10-40% of patients and include: 1, 2

  • Hemiparesis or monoparesis (weakness on one side or in one limb) 1
  • Cranial nerve deficits 1
  • Ataxia (coordination problems) 1
  • Hemisensory loss 1
  • Dysphasia or aphasia (speech difficulties, particularly with dominant hemisphere involvement) 1, 3
  • Memory impairment 1

Cognitive and Behavioral Changes

  • Neurocognitive impairment occurs in 30-40% of patients 2
  • Personality changes 1
  • Poor school performance in school-age children 1
  • Fatigue (the most frequent symptom in stable disease patients) 5
  • Rarely, psychiatric symptoms may be the sole presenting feature 3

Age-Specific Presentations

Infants

  • Increasing head circumference 1
  • Loss of developmental milestones 1

School-Age Children

  • Poor school performance 1
  • Fatigue 1
  • Personality changes 1

Temporal Pattern of Symptoms

Symptoms may develop gradually and worsen over time, or occur suddenly (such as with an acute seizure). 1 The rate of symptom progression often correlates with tumor grade, with high-grade gliomas typically presenting more acutely. 1

Common Pitfalls in Recognition

Evaluation for brain tumor is indicated in any patient with chronic, persistent headache associated with protracted nausea, vomiting, seizures, changes in headache pattern, neurologic symptoms, or personality changes. 3 Clinicians should maintain high suspicion when headache patterns change or when neurological symptoms accompany headaches, as these features distinguish tumor-related headaches from primary headache disorders.

High-Grade Glioma Specific Features

High-grade astrocytomas (grades III-IV) typically present with symptoms of increased intracranial pressure, seizures, or focal neurologic findings related to tumor size, location, and associated peritumoral edema. 1 These tumors produce considerable edema and mass effect, with more than 65% of anaplastic gliomas and 96% of glioblastomas showing contrast enhancement on imaging. 1

End-Stage Symptoms

In the terminal phase (last 10 days), the most frequent signs include: 6

  • Decreased level of consciousness (95% of patients) 6
  • Fever (88%) 6
  • Dysphagia (65%) 6
  • Seizures (65%) 6
  • Headache (33%) 6

Diagnostic Approach

Conventional MRI without and with gadolinium-based contrast is the diagnostic gold standard for detecting brain tumors and should be the first imaging modality when glioma is suspected. 1 Imaging is always recommended to investigate the etiology of emergent signs and symptoms. 1

References

1
Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

3
Research

Malignant gliomas: early diagnosis and clinical aspects.

Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology, 2011

4
Research

Presenting signs and symptoms in brain tumors.

Handbook of clinical neurology, 2016

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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