Senior Director & HOD, Neurosurgery, Fortis Hospital, Noida
Part 2 of 9 in Diagnosis and Management of Brain Tumour
Recognising a Brain Tumour Early: Symptoms and Diagnostic Workup
September 6, 2026
A brain tumour rarely announces itself the same way twice. In his Jivo Healthcare masterclass, Dr. Rahul Gupta, Senior Director of Neurosurgery at Fortis Hospital, Noida, walked through how location, more than tumour type, decides which symptoms actually show up in clinic.
Headache and seizures need context
Headache can be mild or severe, continuous or intermittent, and is often accompanied by vomiting. Seizures, focal or generalised, point toward involvement of the motor cortex, brain stem or thalamus, so their pattern is itself a localising clue rather than just a symptom to control.
Vision, hearing and hormones as location markers
Vision abnormalities localise to suprasellar, orbital or occipital tumours, while hearing loss is associated with acoustic neuromas. Pituitary tumours can be secretory or non-secretory: a secretory tumour can cause a thyroid abnormality, hyperprolactinaemia, or abnormal growth hormone leading to gigantism, along with hyper- or hypo-secretion of cortisol.
When a brain tumour looks psychiatric
A frontal lobe tumour can change behaviour enough that the patient visits a psychiatrist rather than a neurologist or neurosurgeon. Large tumours cause drowsiness or sudden loss of consciousness, sometimes from bleeding inside the tumour itself. Tumours on the dominant hemisphere, especially the temporal, posterior temporal or inferior frontal lobe, cause speech difficulty, while cerebellar or brain stem tumours present mainly as a gait abnormality. Some tumours are found only incidentally, on an MRI ordered for an unrelated reason.
The examination a scan alone will not replace
Dr. Gupta was direct that a thorough clinical examination still matters: a detailed higher mental function assessment, cranial nerve examination, limb power, sensory testing and cerebellar signs. Just as important is a general physical exam of the chest, abdomen and lymph nodes, since metastasis is the most common brain tumour overall, along with the skin, since conditions like neurofibromatosis present with characteristic skin changes and spots. Because lesions can occur at multiple sites, he examines the spine alongside the brain rather than treating them as separate problems.
MRI over CT, and why the gap matters
MRI is the most important and informative investigation once a brain tumour is suspected. A plain scan can still miss a tumour, so contrast MRI is necessary, and special sequences add information on tumour quality, functional brain areas and white-matter tracts through tractography. CT still has a role: it helps in follow-up and shows midline shift, bone status and hydrocephalus. But it is less sensitive than MRI, a plain CT can miss up to 10 percent of tumours, and it should never be relied on alone to rule one out. Cerebral angiography is occasionally added to assess a tumour's vascularity.
This guide is based on a live Jivo Masterclass: Dr. Rahul Gupta taught doctors across Africa on February 9, 2025.
FROM THE LIVE Q&A
Moderator
What are the post-operative complications of brain tumour surgery?
Dr. Rahul Gupta
The most important are seizures and post-operative brain edema. There can be neurological deficits if the motor cortex or another important area was operated on, and nerve injury if the surgery involved the skull base. Uncommonly, there can be post-operative hemorrhage or infection.
Frequently Asked Questions
What are the important post-operative issues to follow, and how often should a brain tumour patient have follow-up imaging?▼
Patients need regular follow-up with the neurosurgeon and repeated imaging. If it is a malignant tumour, a contrast MRI is needed roughly every 3 to 6 months. If the patient has a benign tumour and surgery went well, the MRI can be repeated once a year.
In which type of brain tumour is the prognosis so poor that surgery, chemotherapy and radiotherapy offer no benefit?▼
This applies mainly at the extremes of age: very large tumours in infants, or very large tumours in elderly patients involving critical areas of the brain. For brain stem and deep-seated thalamic gliomas presumed to be malignant, a biopsy may not even be taken, since these are treated directly with radiotherapy. Glioblastomas (grade 4 gliomas) carry a poor prognosis, though chemotherapy and radiotherapy can still extend survival and quality of life for that shorter span of time.
How can post-operative complications be reduced in a resource-limited area?▼
Four things are essential. MRI is mandatory, brain tumour surgery should not be performed without it. An operating microscope is needed for magnification, even a basic one without fluorescence or navigation add-ons. The anaesthetist needs to be equipped and experienced in controlling brain swelling and blood pressure during surgery, ideally with a year or two of experience at a neuro centre. And a post-operative ICU with ventilator support is needed, since some patients require ventilation for a day or two. Good post-operative ICU care alone can reduce complications by 25 to 30 percent. With these four in place, superficial tumours such as meningiomas, surface gliomas and straightforward intraventricular tumours can be safely removed; difficult tumours should still be referred to a better-equipped centre.
What is the commonest brain tumour, and which type has the worst prognosis?▼
Metastasis used to be the most common brain tumour, but with better radiotherapy and chemotherapy most metastatic cases are now managed by radiation and medical oncology rather than surgery, except when a solitary large metastasis is causing a symptomatic mass effect. The tumours operated on most often today are gliomas and meningiomas. Gliomas run from grade 1 to grade 4, and grade 4 glioblastomas have the worst prognosis. Meningiomas usually have a good prognosis, though some are atypical or malignant and located at difficult skull-base sites near major vessels; those can be treated with modern radiotherapy such as gamma knife or cyberknife after a subtotal resection. Pituitary tumours are third most common and are usually benign, approached endoscopically through the nose.
After surgery, do all patients systematically need rehabilitation?▼
Yes. All patients need post-operative care from a team of physiotherapists and rehabilitative support. About 90 percent of patients who arrive without deficits leave hospital without one, but even they need psychological support, and patients with malignant tumours need considerably more of it given the chemotherapy and radiotherapy ahead. Patients need to see the neurosurgeon and physiotherapist regularly for at least 3 to 6 months, and continue lifelong follow-up MRIs.
Can a plain CT scan rule out a brain tumour?▼
No. A plain CT can miss up to 10 percent of brain tumours, so it should never be relied on alone to rule one out; contrast MRI is the investigation of choice.
Why does a brain tumour work-up include a general physical exam?▼
Because metastasis is the most common brain tumour overall, so the chest, abdomen and lymph nodes need checking, and skin changes can point to a hereditary syndrome such as neurofibromatosis.
Can a brain tumour cause a psychiatric-looking change in behaviour?▼
Yes. A frontal lobe tumour can change behaviour severely enough that the patient sees a psychiatrist before a neurologist or neurosurgeon.
In This Series: Diagnosis and Management of Brain Tumour
- 1.Diagnosis and Management of Brain Tumours
- 2.Recognising a Brain Tumour Early: Symptoms and Diagnostic Workup
- 3.The Principles Behind Every Brain Tumour Operation
- 4.Awake Craniotomy and Neuronavigation for Tumours in the Brain's Eloquent Areas
- 5.Fluorescence-Guided Surgery and Real-Time Imaging Inside the Operating Theatre
- 6.Reaching Pituitary and Vascular Brain Tumours Without a Wide Craniotomy
- 7.Brain Tumour Surgery in Children: Two Cases That Show What Changes
- 8.Recovery, Follow-Up and Prognosis After Brain Tumour Surgery
- 9.Delivering Safe Brain Tumour Surgery Where Resources Are Limited