FFinalistSouthampton · 2027
Neurology
AKT · Neurology/Infection & structural

Brain tumours

Primary (glioma, meningioma) or secondary (metastatic) intracranial neoplasm

Overview

Primary or, more commonly, METASTATIC intracranial tumours. They present with progressive focal deficit, raised-ICP headache (worse on waking/lying), seizures, or personality change. The exam tests the subtype clues and the steroid-for-oedema point.

Recognise

  • Progressive headache (worse in the morning/lying down/coughing), nausea, papilloedema (raised ICP)
  • New focal deficit, new seizures in an adult, personality/cognitive change
  • Metastases (commonest — lung, breast, melanoma, renal, GI); primaries: glioblastoma (aggressive), meningioma (benign, dural tail)

Red flags

  • New seizure in an adult, progressive focal deficit, raised-ICP features → urgent imaging; impending herniation

Differentials & how to tell them apart

Brain abscessring-enhancing but with fever + infective source
Cerebral metastasis vs primarymultiple lesions + known cancer favour metastases
Demyelination (MS)younger, disseminated lesions, no mass effect
Strokesudden onset, vascular territory

Investigations

MRI with contrast (the key test); biopsy/resection for histology; search for a primary if metastasis suspected (CT chest/abdo/pelvis).

Management

MRI + neuro-oncology referral; dexamethasone for symptomatic peritumoural oedema

  1. 1MRI with contrast; refer to neuro-oncology. Dexamethasone for symptomatic vasogenic oedema/raised ICP; anticonvulsants for seizures.Gate: Dexamethasone helps tumour-associated (vasogenic) oedema — it is NOT used for the cytotoxic oedema of stroke or trauma
  2. 2Histological diagnosis (biopsy/resection); tumour-specific surgery/radiotherapy/chemotherapy; if metastasis, find and treat the primary.
Dexamethasone — reduces vasogenic peritumoural OEDEMA (symptom relief) — NOT for stroke/trauma oedema
Anticonvulsants — for seizures
Definitive: surgery/radiotherapy/chemotherapy — tumour-specific

Key points

New adult seizure or progressive focal deficit + morning headache → image for a tumour. Steroids for tumour oedema (not stroke). Bitemporal hemianopia → pituitary/suprasellar; cerebellopontine angle → vestibular schwannoma.

Monitor & prognosis

Neuro status, imaging response, steroid side effects, seizures.

Depends on type — meningioma often curable, glioblastoma poor.

Source: NICE NG99 (brain tumours); neuro-oncology