NEUROLOGIC SYMPTOMS BRAIN TUMORS

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NEUROLOGIC SYMPTOMS BRAIN TUMORS
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Topic Includes

• Clinical history
• Presentation / signs
• Diagnosis
• Classification
• Treatment overview
• Management of common tumors

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Pediatric Brain Tumors

• Commonest Solid Tumors
• Symptoms mimic other conditions
• Delay in diagnosis possible
• High index of suspicion necessary
• Long term survivors more than 60

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Case 1

• Clinical Summary
• 06 year, female child
• Complaints Headache, vomiting
• Unsteadiness of gait / difficulty in walking/
  swaying visual deterioration

Clinical signs No cranial nerve palsy No sensory
/ Motor deficit Conscious / cooperative Reflexes
(N) Rhombergs sign absent
Bilateral papillodema () Broad based gait Falls
on either side (Lt) gt (Rt) (Lt) cerebellar signs
positive
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• Case 2
• Clinical summary
• 07 year male child complaints difficulty in
  swallowing/speech weakness (Rt) side of body,
  double vision, altered sensorium.

• Case 3
• Clinical summary
• 14 year male child, complaints headache,
  seizures, memory loss

Possible diagnosis Brain tumor/neoplasm
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Normal Anatomy of Brain (MRI)

• Supratentorial compartment
• Cerebral hemispheres
• Basal ganglia
• Thalamic nuclei
• Lateral ventricles
• Hypothalamus
• Corpus callosum
• Infratentorial compartment
• Cerebellum
• Brain stem (MB/P/MO)
• 4th ventricle

Sagittal
Axial
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Clinical Symptoms

• Location / age
• Non localised / raised intracranial pressure
• Localised

• Nonlocalised
• Tumor mass
• Blockage of CSF pathways
• Weight loss, listlessness, irritability,
  decreased appetite, lethargy / withdrawn
  behaviour, headache, vomiting, double vision.

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Clinical Symptoms
Localised

• Infratentorial tumors
• Symptoms of ?ICP
• Imbalance / Swaying
• Diplopia, swallowing difficulty
• Intrinsic brain tumors
• Diplopia, swallowing and breathing difficulty,
  weakness limbs, swaying ? ICP

• Supratentorial tumors
• Weakness of limbs, loss of sensation, abnormal
  vision, learning difficulty, memory loss,
• Deep midline tumors
• Obesity, visual complaints, growth abnormalities.

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Clinical Signs

• Non-localised
• Papillodema, head circumference, malaligned eyes,
  cranial nerve palsy (6th)
• Localised
• Infratentorial tumors
• Ataxia, defects in co-ordination, nystagmus,
  abnormal speech.
• Intrinsic brain tumors
• Cranial neuropathy, long tract signs, ataxia.
• Supratentorial tumors
• Hemiparesis, hemisensory, visual field
  abnormalities, cognitive/learning difficulties,
  seizures.
• Deep midline tumors
• Endocrinopathies, visual acuity and visual, field
  abnormalities, Parinauds syndrome.

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Pediatric Brain TumorsDiagnosis

• Imaging
• CT scan (plain contrast)
• MRI with Contrast (Gd)

MRI preferred ?sensitivity ?resolution ?three
planer views
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Pediatric Brain Tumors

• Posterior fossa neoplasm Medulloblastoma

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Pediatric Brain Tumors

• Intrinsic pontine glioma

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Pediatric Brain Tumors
Supratentorial tumors Astrocytoma ependymoma

• Pinealoblastoma craniopharyngioma

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Pediatric Brain TumorsDiagnosis

• Histologic
• Craniotomy / Tumor resection
• CT/MRI / STB
• Exception ? Pontine glioma

• Classification
• Histology
• Location Differs from adult brain neoplasms
• Low grade ?
• Infratentorial ?

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Common Brain Tumors
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• Medulloblastoma undifferentiated, barophilic
  round to oral nuclei with minimal perceptible
  cytoplasm

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Distribution of common brain tumors in children
location and histologic appearance
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Distribution of common brain tumors in children
location and histologic appearance
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Distribution of common brain tumors in children
location and histologic appearance
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Staging Work up

• Dissemination extraneurally rare staging work
  up seldom indicated
• Spinal MRI/CSF cytology mandatory
  Medulloblastoma, PF ependymoma, Germ cell tumor
• Blood / CSF - ?FP, ?Hcg Germ cell tumors

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Treatment General principles

• Surgery
• Diagnosis
• Tumor burden is decreased/reduced
• CT/MRI Guided STB
• Open biopsy / extensive microsurgical resection

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Perioperative Management
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Treatment General principles

• Radiotherapy
• High energy machines
• Volume Craniospinal irradiation, localised
  irradiation
• Dose 50-60 Gy / 24-36 Gy, 180-200 Gy /
• STRS/STRT Interstitial brachytherapy /
  conformal and intensity modulated treatment
• Delay/defer irradiation for children younger than
  3 years

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Treatment General principles
Chemotherapy
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Infratentorial Tumors
Medulloblastoma Sx ? Adjuvant Treatment

• High risk
• M1
• gt1.5 cms residual tumor
• lt3 years
• RT CT

• Standard risk
• RT
• ?CT

• Cerebellar Astrocytoma
• Ependymomas
• Brain stem glioma

• Sx alone ?RT (adjuvant)
• Sx ? Adjuvant RT
• RT alone

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Supratentorial Tumors
Midline Supratentorial Tumors

• Optic pathway/ Sx ? ? CT ? ? RT
• Hypothalamic
• Gliomas
• Craniopharyngioma Sx ? RT
• Pineal region tumors Individualized treatment

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THANK YOU
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