Occipital lobe tumors encompass numerous neoplastic processes of different etiologies and clinical stages. The most important primary brain tumors that have been identified in the occipital lobe are tumors of neuroepithelial tissue (mainly gliomas, particularly low-grade), but vascular (such as hemangioendothelioma), mesenchymal (myxomas), and several other tumor types were also documented in the literature [1] [2] [3] [4]. Similarly to other brain tumors, headaches and seizures are common symptoms in this patient population [5] [6]. However, a suspicion toward an occipital lobe tumor can be made in the presence of visual disturbances [1] [5]. Visual hallucinations (that may or may not be accompanied by seizures) are some of the most frequent findings, presenting as light flashes consisting of different shapes, whereas prosopagnosia (inability to recognize previously known faces) is an important component of the clinical presentation [2]. Furthermore, patients with severe and expanding tumors that cause the destruction of one of the occipital lobes will suffer from homonymous hemianopia on the contralateral side [2]. When both lobes are affected, cortical blindness that is negated by patients (known as Anton syndrome) may be encountered [2]. In these cases, patients clearly state that they can see, despite a clinically confirmed absence of vision [2].

• Sighing

  (A sigh of relief!) If you had any part of your occipital lobe removed, you would have felt it a lot more! I just hoped that no surgeon had to do something like that just to get to the tumor. [anausa.org]

• Photophobia

  Her headache was characterized by recurrent episodes of visual aura confined to the left visual field followed by right hemicranial throbbing headaches accompanied by nausea, photophobia, and phonophobia. [miami.pure.elsevier.com]

  […] and Broca's area in front of motor cortex perimysium connective tissue sheath surrounding a bundle of muscle fibers petit mal seizure see absence seizure phonophobia abnormal intolerance to sound that commonly occurs in migraine and other headaches photophobia [strokecenter.org]

• Scotoma

  Scotoma The Peristriate region of the occipital lobe is involved in visuospatial processing, discrimination of movement and color discrimination. [braininjury-explanation.com]

  […] visual migraine aura consisting of shimmering lights followed by a dark spot or partial loss of vision that may move across the visual field scotoma island-like gap or blind spot in the visual field; pleural scotomata secondary progressive clinical course [strokecenter.org]

• Facial Pain

  Volume 1 covers the visual sensory system, the autonomic nervous system, the ocular motor system, the eyelid, facial pain and headache, and nonorganic disease. [books.google.com]

  Man with facial pain. Ludwig’s angina. Ann Emerg Med 2013; 61:278-288 52 Karus D, Raveis VH, Alexander C, Hanna B, Selwyn P, Marconi K, Higginson I. [ghrnet.org]

  pain due to a lesion in the apex of the temporal bone grand mal seizure see tonic-clonic seizure graphesthesia ability to recognize letters or numbers drawn on the finger or palm gray matter part of the CNS consisting of neuronal cell bodies and dendrites [strokecenter.org]

• Visual Hallucination

  Visual hallucinations (that may or may not be accompanied by seizures) are some of the most frequent findings, presenting as light flashes consisting of different shapes, whereas prosopagnosia (inability to recognize previously known faces) is an important [symptoma.com]

  Occipital lesions can cause visual hallucinations. Lesions in the parietal-temporal-occipital association area are associated with color agnosia, movement agnosia, and agraphia. [en.wikipedia.org]

  The anatomy of conscious vision: an fMRI study of visual hallucinations. Nat Neurosci 1998 ; 1 : 738 –42. Cummings JL, Mega MS. Neuropsychiatry and behavioural neuroscience. Oxford: Oxford University Press, 2003. [jnnp.bmj.com]

  hallucinations, and parkinsonism and defined pathologically by cortical (as well as nigral) Lewy bodies diplegia see paraplegia diplopia double vision dissociated sensory deficit impairment of pain/temperature sensation with preservation of vibration [strokecenter.org]

• Compulsive Behavior

  Presentation varies from small motor tics, unusual perceptual disturbances, time-distortion, derealization, panic-like sxs, compulsive behaviors, catatonic variants, atypical aggressive outbursts, obsessions, and much more. [healthtap.com]

• Headache

  Similarly to other brain tumors, headaches and seizures are common symptoms in this patient population. However, a suspicion toward an occipital lobe tumor can be made in the presence of visual disturbances. [symptoma.com]

  KW - brain tumor KW - headache KW - migraine with aura UR - UR - U2 - 10.1046/j.1526-4610.1996.3601049.x DO - 10.1046/j.1526-4610.1996.3601049.x M3 - Article VL - 36 SP - 49 EP - 52 JO - Headache T2 - Headache JF - Headache SN - 0017-8748 IS - 1 ER - [miami.pure.elsevier.com]

  When the headache returns, the concern is if the tumor is back or if it is precipitating migraine headaches. Migraine headaches can be precipitated by structural lesions(such as tumors), but care must be taken to rule out other causes. [medhelp.org]

  This case illustrates that headache fulfilling the International Headache Society (IHS) criteria for migraine with typical aura can occur in association with an occipital lobe tumor. [ncbi.nlm.nih.gov]

  In conjunction with the headache I would have congestion and an intermediate earache. I thought it was my sinuses so I would take sinus headache medication but that did not stop the pain. [healthboards.com]

• Aura

  @article{2fe013b57d98484f8a8f34febf60ca69, title "Occipital lobe tumor presenting as migraine with typical aura", abstract "We report the case of a 60-year-old woman in whom migraine with typical aura heralded the presence of an occipital lobe tumor. [miami.pure.elsevier.com]

  We report the case of a 60-year-old woman in whom migraine with typical aura heralded the presence of an occipital lobe tumor. [ncbi.nlm.nih.gov]

  (classic migraine) migraine attack associated with reversible aura symptoms indicative of focal CNS dysfunction; the aura ( scintillating scotoma, vertigo, paresthesias, paresis, etc) typically develops gradually over several minutes, lasts less than [strokecenter.org]

  A simple partial seizure can be a precursor to a larger seizure and then it is called an aura. A complex partial seizure affects a larger part of the hemisphere and the person may lose consciousness. [radiologyassistant.nl]

• Throbbing Headache

  Her headache was characterized by recurrent episodes of visual aura confined to the left visual field followed by right hemicranial throbbing headaches accompanied by nausea, photophobia, and phonophobia. [miami.pure.elsevier.com]

  headache arising exclusively during sleep, typically between 1:00 and 3:00 AM hypnic jerk sensation of falling, and then "jerking" awake just as one drifts to sleep hypnopompic hallucination vivid dreamlike hallucination that occurs as one is waking [strokecenter.org]

• Sinus Headache

  I thought it was my sinuses so I would take sinus headache medication but that did not stop the pain. [healthboards.com]

  He finally accepted it wasn't sinus headaches only when he started violently vomitting for 2 days before going to the hospital. On December 1st, a CT and MRI confirmed a 3.8cm mass in his occipital lobe. [inspire.com]

• Homonymous Hemianopsia

  Clinical significance [ edit ] If one occipital lobe is damaged, the result can be homonymous hemianopsia vision loss from similarly positioned "field cuts" in each eye. Occipital lesions can cause visual hallucinations. [en.wikipedia.org]

The diagnostic workup of patients in whom an occipital lobe tumor is suspected should start by conducting a thorough patient history, which will assess the onset of complaints, their progression, as well as severity. If patients report progressive visual symptoms (with or without headaches or epilepsy), a thorough examination of visual fields and acuity should be performed in order to assess the localization of the deficits. After sufficient clinical evidence has been gathered, imaging studies need to be employed; these are the gold standard for diagnosing brain tumors [1] [4]. MRI, using T1 and T2-weighted studies with gadolinium as a contrast, as well as fluid-attenuated inversion-recovery (FLAIR) sequence imaging, is considered to be the first-line study that allows identification of the exact location and the characteristics of the lesion [1] [3] [4] [6] [7]. When MRI is contraindicated (for example, in the presence of foreign metallic bodies or pacemakers), CT of the endocranium serves as an alternative [1] [4]. More advanced techniques are indicated when further diagnosis and treatment planning is required, such as functional MRIs (fMRI), MR proton spectroscopy, single photon emission tomography (SPECT), positron-emission tomography (PET), or visual evoked potential [6] [8] [9]. A definite classification of the tumor type is made from imaging findings and biopsy samples obtained either preoperatively or postoperatively [1] [4].

1. Perkins A, Liu G. Primary Brain Tumors in Adults: Diagnosis and Treatment. Am Fam Physician. 2016;93(3):211-217.
2. Pan E, Prados MD. Clinical Presentation. In: Kufe DW, Pollock RE, Weichselbaum RR, et al., editors. Holland-Frei Cancer Medicine. 6th edition. Hamilton (ON): BC Decker; 2003.
3. Verma A, Rosenfeld V, Forteza A, Sharma KR. Occipital lobe tumor presenting as migraine with typical aura. Headache. 1996;36(1):49-52.
4. Amit A, Bhake A, Banode P, Singh BR. Malignant hemangioendothelioma of occipital bone. Chin J Cancer Res. 2012;24(2):161-163.
5. Kawatra M, Bhandari V, Phatak S, Kulkarni D. Primary occipital myxoma: A rare case report. J Pediatr Neurosci. 2013;8(2):129-131.
6. Schneider T, Mawrin C, Scherlach C, Skalej M, Firsching R. Gliomas in Adults. Dtsch Arztebl Int. 2010;107(45):799-808.
7. Tatsuzawa K, Owada K, Sasajima H, Yamada K, Mineura K. Surgical strategy of brain tumors adjacent to the optic radiation using diffusion tensor imaging-based tractography. Oncology Letters. 2010;1(6):1005-1009.
8. Roux FE, Ibarrola D, Lotterie JA, Chollet F, Berry I. Perimetric visual field and functional MRI correlation: implications for image-guided surgery in occipital brain tumours. J Neurol Neurosurg Psychiatry. 2001;71:505–514.
9. Lacerda S, Law M. Magnetic resonance perfusion and permeability imaging in brain tumors. Neuroimaging Clin N Am. 2009;19(4):527-557.