The classic cardinal symptoms of increased intracranial pressure are lacking in from 15 to 30 per cent of large groups of patients with intracranial tumors, according to the studies of many observers. Since a diagnosis of cerebral neoplasm is rarely made in the absence of pressure phenomena, it is our belief that many more patients die of unrecognized cerebral neoplastic disease than the reports in the literature would indicate.
Headache, the most prominent symptom of brain tumor, is absent in at least 10 per cent of cases,1 while papilledema, considered by many observers the most valuable pressure sign, is absent in from 15 to 30 per cent of cases.2 Vomiting, usually a late symptom dependent on high grade internal hydrocephalus, occurs still less frequently. Other pressure phenomena are more uncommon. Headache, vomiting and choked disks are present together in only about 60 per cent of cases.1
BENNETT AE, KEEGAN JJ. CEREBRAL NEOPLASMS: THE DIAGNOSIS IN THE ABSENCE OF GENERALIZED INTRACRANIAL PRESSURE PHENOMENA. JAMA. 1935;104(1):10–17. doi:10.1001/jama.1935.02760010012003
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