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BRAIN TUMORS:
Epidemiology:82/100000
20% of malignancies of<15 years
Incidence peak in childhood
increase from20 to70 years decease>70
Glioma M>F Meningioma F>M
In childhood:Medulloblastoma&
Astrocytoma
In adults:Glioma&Meningioma
In childhhod:70% infratentorial
In adult:70% supratentorial
Survival in children is better
Risk factors:
stroke,menopose,breast
cancer,farmacotics
EBV
CNS lymphoma
JCV
PML
Astrocytoma
Radiation
Antioxidants--------preventive
Clinical Diagnosis:
Mass effect-Edema-IICP
Negative &Positive Signs
Headache
Vomiting
Facial pain
Seizure(30-70%)-focal
Changes of conciousness(frontal)
Frontal SOL:silent-personalitydisorder
Abulia-Judjment dis-incontinencyPrimitive reflexes
Occiputal SOL:Visual field changes
Temporal SOL: Seizure-AphasiaVisual field disturbance
Parietal SOL: Cortical sensoryloss
Neglect-AnosognosisHemiparesis-Visuospatial D
Thalamic SOL: Hemisensoryloss
Brain stem SOL: Cranial nerve palsy
Hicough-Vomiting-Hemiparesis
Pineal SOL: Parinaud syn.-Premature
Puberty-Hydrocephalus
Cerebellar SOL; Headache-Vomiting
Neck stiffness-Ataxia
Acoustic neuroma; Deafness-Facial
weakness-vertigo
Pituitary adenoma: Bitemporal hemianopia
Neuroophthalmologic signs:
Parinaud syn.-Ptosis-papiledemaOptic atrophy-Foster kennedy syn.
Laboratory Findings:
Skull x ray-Brain CT scan&MRIAngiography-MRA-PET&SPECT
Evoked potentials-EEG
D.D: Stoke-Infection-MS-Sarcoidosis
meningiomas: F>M-6th&7th decadechildhood(rarely)-90% intracranial
Ethiology; Radiation-Trauma?-
progestrone-Viral
Clinical Manifestations: SeizureHemiparesis-cranial palsy-IICP
Imaging:x ray-CT-MRI-MRA
Treatment:Resection-RadiothrapyProton beam- Mifepristone(RU486
-Chemothrapy(Ifosfamide)-AEDs
Gliomas:60%primary brain tumors
low grade- high grade
<25 years67% infratentorial
>25years 90% supratentorial
Location: white matter (frontaltemporal-frontoparietal)
Symptoms: Seizure-focal deficitsMemmory& personality disturbance
Treatment: Resection-radiationchemotherapy (carmustin& procarbazin)
Oligodendroglioma: Sensitive to
chemothrapy-5% SOL-50YEARS
Symptoms: Seizure-focal deficit
Imaging: Hypodensity-calcification
Treatment: Resection –RadiationChemothrapy(PCV-CCNU)
Ependymoma:3-5years-vomiting
Hydrocephalus
Location: Ventricles-spinal cord
Treatment: Resection-Radiation
PNET: Childhood-Mitosis-Invasive
Medulloblastoma: Vermis
Treatment: Mixed thrapy
Brain Metastasis
The most common direct neurological
complication of
Systemic cancer
BM>primary malignant brain tumor
times
10
Prostate cancer 1%BM
3% BM
ovarian cancer
Melanoma 18-90%BM
lung cancer 18-
Breast cancer 20-30%BM
20-40% dying with cancer have BM
BM causes :lung(40-50%)breast(15-20%)-melanoma&
GI and renal (every one 5-10
BM 80% supratentorial
Pelvic &GI cancer infratentorial
Initial manifestation of unknown systemic tumor 10-30%
Lung cancer:the most common cause of BM presentig
Without a known primary (66%) NSCLC –GI(10%)
Intratumoral hemorrhage; melanoma-choriocarcinomathyroid &renal cell carcinoma
Clinical presentation
may arise as long as 20 years after discovery
of the primary tumor (breast-melanoma)
may antedate discovery primary tumor (lung)
progressive over days or weeks (occasionally
acute seizure or stroke like)
Headache 50%-mental status changes 33%
tension like –classic brain tumor headache is
uncommon
Headache without other symptoms
compatible
With multiple metastasis
Nausea- vomiting-drowsiness- unilateral
weakness- gait disturbance- seizure
Signs :hemiparesis &mental status
changes
(the most common 60%)- IICPpappiledema(10%)
D D :primary SOL-abcess- MS- stroke
PML- radiation therapy
Neuroimaging:T2 MRI detect >1cm
diameter
MRI with gadolinium
improved sensivity
multiple metastasis (70-75%)
Pituitary tumors:2/7-27%
M=F
3&4 DECADE-Sporadic-10% inchildhood
Secratory&Nonsecratory
Prolactinoma; Most common
Mixed: 10%
Microadenoma---Macroadenoma
Pituitary tumors:2/7-27%
M=F
3&4 DECADE-Sporadic-10% inchildhood
Secratory&Nonsecratory
Prolactinoma; Most common
Mixed: 10%
Microadenoma---Macroadenoma
Adenocarcinoma:Rarely
Clinical Manifestations:
Mass effect(headache&visual loss
&hypopituitarism)papilledema(rare
Dysfunction of ocular nerves-IICP
-DI-Seizure-hemiparesis-
Management:
Evaluation of endocrine-thyroid&
adrenal replacement-Bromocriptin
-Resection-Radiothrapy
Pituitary apoplexy:
sever headache-vomiting-nausea
SPINAL TUMORS :
Divided by location : 1)intramedullary
2)intradural
3)extradural
intramedullary are rare 10%
intradural” menengioma-neurofibroma
benign encapsulated 65%
IM more common in childhood
EM are more common in adults
The most common primary sites of
metastasis :a)lung b) breast c)prostate
d)GI,lymphoma,melanoma,renal,….
M=F
SPINAL/BRAIN= 25%
meningioma F>M
ependymoma
>F
Spinal
mors occur prodominant
in young or middle aged and are
less common in childhood or after age 60 years
most often ln thoracic region
Symptoms :
Intradural : compression nerve
roots-(dorsal)-ultimately complete
loss of function below the level of the lesion
1)focal pain &paresthesias 2)
sensory loss weakness,wasting
3)cord compression(spastic weak
impairment of sensation-impaired
control of bladder and rectum
Symptoms continued:
overactive DTR –Babinsky sign
loss of superficial abdominal
reflex
Spinal Metastasis :5-10%of all
cancer patients
Epidural spinal cord compression
treatment of cord compression
does not prolong survival but may
relieve pain and prevent disability
Neck or back pain persists when
the patient lies in bed even if the
pain relieved by analgesics.
Limb weakness –paresthiasis in
the distribution of nerve rootor bladder dysfunction
Rarely the only manifestation of
cord compression is a gait disorder
(sensory ataxia or spinocerbellar)
Lung-breast-GI-prostate-melanoma
=>80% of original site
Treatment is palliative
Loss of bladder or bowel is an
Ominous prognostic sign and is
Usually irreversible
Radiotherapy is treatment of
Choice
melanoma_surgical T
Intramedullary metastasis:
The most common sites :lung or
breast 60% multiple metastasis
Death 3 months of diagnosis 80%
Primary intramedullary tumors:
usually extend over many
segments- if restricted to 1-2
the syndrome is similar to that
of an extramedullary tumor
sacral sparing- syringimyelia
Intradural tumors
neurofibroma: the most common
meningioma- schwannoma