Persistent vomiting is often initially ascribed to gastrointestinal disease, and even if there is no accompanying headache, the possibility of a brain tumor must be considered. In this setting, a focal tumor of the medullary vomiting center is a possibility. Since these may be difficult to visualize with CT scan due to bone artifact, an MRI is the best diagnostic test. Visual complaints may also suggest a brain tumor. Progressive visual loss with optic atrophy and visual field abnormalities suggests a mass in the region of the optic nerves or chiasm.
Patients often are unaware of nystagmus, which suggest a process in the cerebellum or brainstem.
Papilledema is a non-specific accompaniment of increased intracranial pressure, but its absence does not exclude a brain tumor. Bleeding into a previously unrecognized brain tumor is not infrequent, and biopsy of the wall of a hematoma cavity is indicated for any unexplained spontaneous intracerebral bleed. Other symptoms are less common. Hemiparesis may arise from the supratentorial compartment or brainstem. Paraparesis usually arises from a spinal process, but may rarely occur with midline lesions of the falx cerebri which distort the leg motor areas in the interhemispheric fissure.