What is the most frequent presenting symptom of an intracranial neoplasm?

Headaches are the most frequent presenting symptom of an intracranial neoplasm due to several factors related to the potential effects of a tumor on the brain and the surrounding tissues. As a mass grows within the confined space of the cranial vault, it can increase intracranial pressure and lead to the activation of pain pathways in the meninges and surrounding structures. Headaches associated with brain tumors can be characterized by their gradual onset, worsening over time, and may be accompanied by other symptoms such as nausea or neurological deficits.

While seizures, nausea, and visual changes can all occur in the setting of an intracranial tumor, they are less commonly the first symptom that is reported by patients. Seizures may arise in some cases as a result of cortical irritation by the tumor. Nausea can occur due to increased intracranial pressure or as a consequence of irritation of the brain regions responsible for the vomiting reflex. Visual changes can arise if a tumor affects the optic pathways or other areas related to vision but typically manifest later rather than as an initial symptom. Overall, headache remains the most prevalent symptom due to its direct association with raised intracranial pressure and irritation of pain receptors in the cranial cavity.