The central nervous system (CNS) is affected by a large variety of primary brain tumours and by metastases of cancers originating from other organs. Brain tumours carry a high morbidity and are associated with a range of complications that are rare in cancers affecting other anatomical locations. Neurological symptoms and signs are related to the anatomical area of the CNS involved. There is no symptom or sign specific to primary or secondary brain tumours. Focal or lateralised effects of local tissue destruction include hemiparesis, aphasia and visual field deficits. These lateralised symptoms often present subacutely and show a progressive course over some days or weeks. Leptomeningeal disease typically leads to multifocal signs and symptoms. Most frequently, patients present with headaches, nausea and vomiting, mental changes, gait difficulties, cranial nerve palsies and focal or irradiating (radicular) neck and back pain. 1

Unspecific symptoms of raised intracranial pressure are headache, with or without nausea and vomiting, cognitive impairment, personality changes and gait disturbances. These symptoms are caused by direct pressure of the growing tumour and oedema, or impairment of cerebrospinal fluid (CSF) circulation with consecutive hydrocephalus. The typical holocephalic or unilateral throbbing brain tumour-related headaches are accentuated after supine position, eg in the morning, and improve over a period of upright time during the day. 2