BRAIN TUMORS:

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BRAIN TUMORS Epidemiology82/100000 20
of malignancies oflt15 years Incidence peak in
childhood increase from20 to70 years
deceasegt70 Glioma MgtF Meningioma
FgtM
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In childhoodMedulloblastoma
Astrocytoma In adultsGliomaMeningioma In
childhhod70 infratentorial In adult70
supratentorial Survival in children is better
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Risk factors stroke,menopose,breast
cancer,farmacotics EBV CNS
lymphoma JCV PML Astrocytoma Radiation
Antioxidants--------preventive
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Clinical Diagnosis Mass effect-Edema-IICP
Negative Positive Signs Headache Vomiting
Facial pain
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Seizure(30-70)-focal Changes of
conciousness(frontal) Frontal SOLsilent-personal
itydisorder Abulia-Judjment dis-incontinency-
Primitive reflexes Occiputal SOLVisual field
changes
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Temporal SOL Seizure-Aphasia-
Visual field disturbance Parietal SOL Cortical
sensoryloss Neglect-Anosognosis-
Hemiparesis-Visuospatial D Thalamic SOL
Hemisensoryloss
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Brain stem SOL Cranial nerve palsy
Hicough-Vomiting-Hemiparesis Pineal SOL Parinaud
syn.-Premature Puberty-Hydrocephalus
Cerebellar SOL Headache-Vomiting
Neck stiffness-Ataxia
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Acoustic neuroma Deafness-Facial
weakness-vertigo Pituitary adenoma
Bitemporal hemianopia Neuroophthalmologic signs
Parinaud syn.-Ptosis-papiledema- Optic
atrophy-Foster kennedy syn.
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Laboratory Findings Skull x ray-Brain CT
scanMRI- Angiography-MRA-PETSPECT Evoked
potentials-EEG D.D Stoke-Infection-MS-Sarcoidosis
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meningiomas FgtM-6th7th decade-
childhood(rarely)-90 intracranial Ethiology
Radiation-Trauma?-
progestrone-Viral Clinical Manifestations
Seizure- Hemiparesis-cranial palsy-IICP
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Imagingx ray-CT-MRI-MRA TreatmentResection-Radio
thrapy- Proton beam- Mifepristone(RU486
-Chemothrapy(Ifosfamide)-AEDs
Gliomas60primary brain tumors low grade- high
grade
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lt25 years67 infratentorial gt25years 90
supratentorial Location white matter
(frontal-temporal-frontoparietal) Symptoms
Seizure-focal deficits- Memmory personality
disturbance Treatment Resection-radiation-chemoth
erapy (carmustin procarbazin)
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Oligodendroglioma Sensitive to chemothrapy-5
SOL-50YEARS Symptoms Seizure-focal deficit
Imaging Hypodensity-calcification Treatment
Resection Radiation-
Chemothrapy(PCV-CCNU)
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Ependymoma3-5years-vomiting
Hydrocephalus Location Ventricles-spinal
cord Treatment Resection-Radiation PNET
Childhood-Mitosis-Invasive Medulloblastoma
Vermis Treatment Mixed thrapy
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Brain Metastasis The most common
direct neurological complication of Systemic
cancer BMgtprimary malignant brain tumor 10
times Prostate cancer 1BM ovarian cancer 3
BM Melanoma 18-90BM lung cancer 18-63
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Breast cancer 20-30BM 20-40 dying with cancer
have BM BM causes lung(40-50)-breast(15-20)-mel
anoma GI and renal (every one 5-10
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BM 80 supratentorial
Pelvic GI
cancer infratentorial Initial manifestation of
unknown systemic tumor 10-30 Lung cancerthe
most common cause of BM presentig Without a known
primary (66) NSCLC GI(10) Intratumoral
hemorrhage melanoma-choriocarcinoma-
thyroid renal cell carcinoma
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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
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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)- IICP-
pappiledema(10)
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D D primary SOL-abcess- MS- stroke
PML- radiation therapy NeuroimagingT2 MRI detect
gt1cm diameter MRI with
gadolinium improved
sensivity multiple metastasis
(70-75)

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Pituitary tumors2/7-27 MF 34
DECADE-Sporadic-10 inchildhood
SecratoryNonsecratory Prolactinoma Most
common Mixed 10 Microadenoma---Macroadenom
a
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Pituitary tumors2/7-27 MF 34
DECADE-Sporadic-10 inchildhood
SecratoryNonsecratory Prolactinoma Most
common Mixed 10 Microadenoma---Macroadenom
a
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AdenocarcinomaRarely Clinical Manifestations
Mass effect(headachevisual loss
hypopituitarism)-papilledema(rare Dysfunction
of ocular nerves-IICP -DI-Seizure-hemiparesis-d
ementia
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Management Evaluation of endocrine-thyroid
adrenal replacement-Bromocriptin
-Resection-Radiothrapy Pituitary apoplexy
sever headache-vomiting-nausea

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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,melan
oma,renal,.
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MF SPINAL/BRAIN 25 meningioma
FgtM ependymoma MgtF
Spinal tumors
occur prodominant in young or middle aged
and are less common in childhood or after
age 60 years most often ln thoracic region

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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
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Symptoms continued overactive DTR Babinsky
sign loss of superficial abdominal
reflex Spinal Metastasis 5-10of all cancer
patients Epidural spinal cord compression
treatment of cord compression does not prolong
survival but may relieve pain and prevent
disability
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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 root- or bladder
dysfunction Rarely the only manifestation of
cord compression is a gait disorder (sensory
ataxia or spinocerbellar)
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Lung-breast-GI-prostate-melanoma gt80 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
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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
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Intradural tumors neurofibroma the most
common meningioma- schwannoma
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