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Chapter 20. CEREBRAL TUMOURS

From the clinical viewpoint, cerebral tumours are characterised by cerebral organic and focal symptoms, which are a manifestation of any local pathology.

At the initial stages, neurotic or hypochondriac symptoms are present most often. Patients have heightened shortness of temper, severe fatigability, headaches, and dismnestic disorders.

For worsening of their states, obnubilation can develop, hallucinatory and delusional phenomena occur, there are affects of fear, melancholia, and somnolence. At the same time, focal symptoms can appear in accordance with a certain lesion region: paralyses, epileptiform seizures, hyperkineses. In some cases, seizures begin due to the general increase in intracranial pressure; examining the fundus in such patients, papilledema of the optic nerve and visual weakening are present. Later, vomiting, decreased pulse rate, rickety walk and speech disorders can appear. In some patients, amnestic symptom complex develops. In the cerebrospinal fluid, an increase in protein is detected in the absence of pleocytosis. Studying the local symptoms of a brain tumour makes it possible to determine its location, which is very important for deciding on possible surgical intervention.

Usually, mental disorders in cerebral tumours are divided into stable, ones with a disposition to increase, and short-time, or transitory.

STABLE MENTAL DISORDERS

These include both productive and negative manifestations, which remain unchanged for a long time and subsequently tend to increase.

Sleep Disorders

They are manifested in impairment of the sleep-vigilance rhythm including somnolence during the day and onset of nightmare dreams, which tend to stereotypical reiteration.

Memory Disorders

They manifest themselves by the development of indicators of Korsakoff's syndrome with different degree of severity of all its structural components. Such phenomena are more often present in cases of development of the third ventricle tumour and posterior parts of the right hemisphere. Manifestations of fixative amnesia, paramnesia and amnestic disorientation are pronounced. Against the background of Korsakoff's syndrome, many patients have euphoria and anosognosia. In patients, memory disorders develop with localisation of tumours in the left cerebral hemisphere. They are usually mild and manifested as dismnestic disorders. Patients do not remember names, addresses, phone numbers, the purpose of their actions too. There are constant mood changes too; euphoria turns into dysphoria and vice versa.

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