Spaceoccupying lesions Brain tumours

Their clinical manifestations are determined by the focal damage and by the generalized effects of raised intracranial pressure. Psychiatric symptoms occur at some point in 50 per cent of patients(37) and are of three main types:

1. Confusional states and/or progressive cognitive deterioration occur in a third of patients. Disorientation with variable clouding of consciousness, euphoria, or indifference and loss of insight are prominent in those with confusional states. Progressive memory impairment, loss of initiative, and bradyphrenia are common in those with a more protracted course and often coexist with signs of raised intracranial pressure.

2. Behavioural and mood disturbances occur in 20 per cent of patients. Irritability, euphoria, depression, and, less frequently, psychotic symptoms are part of the picture.

3. Paroxysmal disturbances such as poorly formed visual hallucinations and automatisms, indicating temporal lobe involvement, are less common.

Fast-growing tumours are more likely to cause psychiatric symptoms (60 per cent in patients with gliomas and 42 per cent in those with meningiomas). The possibility of frontal lobe tumours presenting with psychiatric symptoms in the absence of other neurological abnormalities is particularly relevant, (38) although with the availability of imaging techniques the correct diagnosis is usually made early. Emotional symptoms occur in patients with medial and orbitofrontal tumours. Behavioural disinhibition and irritability are common, and marked apathy occurs when the anterior cingulate is involved. Tumours involving the dorsolateral prefrontal regions are more likely to produce abnormalities of executive function (planning, goal-directed behaviour, ability to monitor effective performance). Disturbances of micturition are specifically associated with frontal tumours.

A detailed clinical history and a neurological examination are mandatory, and when the possibility of a space-occupying lesion exists imaging should also be performed (CT or MRI).

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