ABSTRACT
Introduction The diagnosis of central nervous system (CNS) tumors differs quantitatively but not qualitatively from the diagnosis of other neurologic diseases. The qualitative elements of history, general physical examination, neurologic examination and laboratory findings, especially imaging, are the same for all neurologic diseases. However, in most neurologic disorders, such as migraine, epilepsy and even, early in its course, multiple sclerosis, the history is by far the most important element, representing more than 80% of the information necessary for diagnosis. This is because most patients who present for neurologic evaluation have symptoms unaccompanied by neurologic signs or abnormal images. In patients with CNS tumors, the situation is different. This history is quantitatively far less important than the laboratory evaluation. Unless the patient presents with a focal seizure, symptoms may be vague and subtle and resemble those of many less serious neurologic syndromes. For example, one cannot easily distinguish, by history, the headache of brain tumor from that of migraine or tension-type headache (see below). Similarly, it is often hard to distinguish personality change associated with brain tumors from depression or other psychological disorders.
