Dr Sudhir Kumar MD DM Profile picture
Jun 9 13 tweets 4 min read Twitter logo Read on Twitter
Ten lesser-known symptoms that could point towards a diagnosis of brain tumor

June 8th is celebrated as “World brain tumor day” to raise awareness about brain tumors. I would like to focus on the symptoms, presence of which, can make one suspect the presence of brain tumor. twitter.com/i/web/status/1…
Common symptoms of brain tumor include headache, vomiting, reduced alertness, fits & paralysis. However, in several cases, these classical symptoms may be missing. It is important to know the lesser-known symptoms of brain tumors so that they can be diagnosed & treated early.
1. Increase in hat and shoe size over time- A tumor of pituitary gland of brain producing excess growth hormone (GH) causes a condition known as acromegaly, which can result in increasing head and feet size, necessitating a need for larger hats and bigger shoes.
2. Milk production from breasts (in a woman who is not breastfeeding)- This condition is called galactorrhea & is caused by a tumor of pituitary gland that produces excess prolactin hormone. In addition to milk discharge from nipples, these women can also have irregular periods).
3. Loss of vision- Vision loss or blurred vision can occur in brain tumors. The extent and severity of vision loss depends on the location and size of brain tumor. Loss of vision can be on the sides of visual fields, or in one half of the visual field.
4. Loss of smell- Tumors arising in the frontal lobe of brain near olfactory nerve origin can cause loss of smell.
5. Impaired hearing- tumors located in cerebello-pontine angle (in the vicinity of auditory nerve) can cause hearing impairment and tinnitus.
#MedTwitter
6. Depressive symptoms- Patients with tumors of frontal lobe of brain can present solely with features of depression. In a patient with depression, who is aged 50 or more, or if depression is not responding to medical treatment, one should suspect a brain tumor.
#depression
7. Personality changes such as disinhibition (socially inappropriate behavior), agitation and mood swings can also be the presenting features of brain tumor.
#psychtwitter #neurotwitter
8. Rapidly progressive dementia- Memory impairment along with dysfunction of other higher cognitive functions, which are rapidly deteriorating over weeks to months, could signal the presence of an underlying cancerous brain tumor.
#dementia
9. Disease in a body part other than brain- Certain cancers can spread to the brain from other organs, called metastases. For example, a person with cough or blood in sputum along with headache could have lung cancer with spread to the brain.
10. No symptoms- Yes, you heard it right. In many situations, one may not have any symptoms and still harbor a brain tumor. This is more likely if the tumor size is very small. +
10a. +In 7 out of 1000 people, in whom brain scan is done for other purposes (head injury or headache), a brain tumor is detected.
In most such cases, surgery is not needed and follow up brain scans may be needed after 6 months or one year.
Take home message
One needs to be aware of these lesser known (less common) symptoms of brain tumor, so that they can be suspected in a person with those symptoms. This would lead to earlier diagnosis and greater chances of a successful outcome.

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More from @hyderabaddoctor

Jun 8
Litchi encephalitis (chamki bukhar): Facts and Myths

1. Lychee (or litchi) is a fruit, mostly grown in China, India and rest of Southeast Asia. Fruit ripening coincides with Indian summer (May-June).
There is a concern that eating litchi can cause brain fever and death.
2. Litchi does not cause "encephalitis" (brain fever).
No infective agent (virus or other pathogen) has been isolated from CSF or blood of any victim of litchi encephalitis.
Also, it does not spread from person-to-person (what is expected in an infection).
3. How is litchi associated with litchi encephalitis?
Hypoglycin A and Methylene cyclo propyl glycine (MCPG), more commonly found in unripe litchi and depletes glucose reserves in the body. More fatal for under- or malnourished children, who eat unripe litchi on empty stomach.
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Jun 2
10 commonly asked questions about migraine answered
1. Is migraine hereditary?
Migraine is hereditary, so if one or both of your parents have it, there is a 50-75% chance you will too. However, in many patients, there is no family history of migraine.
#MedTwitter #migraine twitter.com/i/web/status/1…
2. Can children get migraine?
Ans: Yes. Migraine occurs in about 3% of preschool children, 4-11% of elementary school-aged children, and 8-15% of high school-aged children. Incidence of migraine increases in adolescence.
3. What are the common symptoms of migraine?
Ans: Headache, nausea, vomiting, intolerance to bright lights and noise.
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Read 11 tweets
Jun 2
Adverse effects of commonly used medicines (at their usual therapeutic doses)

1. Every medicine has adverse effects, especially if taken in higher doses. Some drugs can cause allergic reactions at the usual dose too. Here I describe non-allergic side effects of a few medicines. twitter.com/i/web/status/1…
2. Vitamin B12 deficiency- can occur due to Metformin use for diabetes.
3. Headache and cerebral venous sinus thrombosis (clotting of blood in brain veins)- can occur in women after using hormonal pills (OCPs)
4. Confusion, disorientation and seizures with levofloxacin & similar+
+antibiotics, especially in people aged 60 or more.
5. Parkinsonism- due to use of anti-vomiting drugs; levosulpiride, and anti-psychotic drugs.
Levosulpiride is added to anti-acidity drugs and can be recognized with letter L, as in Pantocid-L, Razo-L, etc
#MedTwitter
Read 6 tweets
May 31
A. Today, one person who recently turned 50 consulted me in OPD. He has no symptoms & is healthy. He has no known diseases. He wanted a check up & advice to ensure he does not convert into a patient for as long as possible. I love this concept of disease prevention.
#MedTwitter
B. It is possible to prevent most of the serious diseases by following healthy lifestyle and proper medical care.
These include:
1. Regular sleep: 7-8 hours per night
2. Regular exercise: 30-40 minutes daily for 5 or more days a week; 9-10 k steps/day; strength training
3. Healthy diet: low carb, high protein diet;
avoid sugar & ultraprocessed packaged foods;
eat fresh fruits & vegetables, handful of nuts per day; early dinner (3-4 hours before sleeping time);
reduce feeding time window;
intermittent fasting at least on a few days per month
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May 30
Me: "Mr Raj, your wife needs operation, and it needs to be done soon."
Mr Raj: "But none of the previous doctors who treated her depression even remotely hinted at this possibility (of surgery)".

1. 55-year old Mrs Viji had started feeling sad in August 2022.
#MedTwitter
2. Their only daughter had moved to the UK for higher studies. It was assumed that her sadness was related to missing her daughter. However, the feeling of sadness increased over time. She became withdrawn and stopped participating in get-togethers with family and friends.
3. Mrs Viji did not improve even after one month, she was taken to a psychiatrist.
After detailed history, she was diagnosed to have severe depression, and was started on anti-depressant medications.
Counseling by a psychologist was also started.
#psychtwitter #psychology
Read 11 tweets
May 29
Investing in a second residential flat for earning rental income or for capital appreciation is not a wise decision

1. Annual returns are 2-4% (lower than 10-12% in mutual funds),
2. Lesser tax efficient (LTCG 20% vs 10% for equity beyond gains of 1 lakh),
#investments #Equity twitter.com/i/web/status/1…
3. Large capital is required to invest into real estate (Mutual funds need lesser capital)
4. Investment in real estate is illiquid (takes time to find the right buyer). For mutual funds, amount is credited into bank account within 2-3 days of redemption.
5. For property, additional costs include property tax, maintenance charges, cost of repairs and repainting. Tax needs to be paid even when the flat is unoccupied, and there are no tenants. These situations do not apply to mutual funds/equity investments.
Read 5 tweets

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