brain tumors د.عبدالرحمن سلام

8/3/2019 Brain tumors .

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BRAIN OEDEMA AND DISORDER OF I.C.T

Brain oedema

Definition : Increase in brain volume due to an

increase in water and sodium content

Classification

1-Vasogenic (extra cellular): Increase capillary

permeability lead to increase extra cellular fluid

which as plasma &plasma protein caused by e.g.

brain tumours,abscess ,infection ,trauma and

haemorrage..


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2-Cytotoxic(cellular): Decrease capillary

permeability lead to increase intracellular fluidwhich as water and sodium caused by hypoxia,

hypo osmalarity e.g. water intoxication.

3- Interstitial (hydrocephalic): Increase brain

fluid especially extra cellular due to block C.S.F

absorption caused by obstructive hydrocephalus


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Hydrocephalus

Definition : Increase cerebrospinal fluid (C.S.F )

volume and dilatation of the cerebral ventriclesClassification :

1- Obstructive: Due to congenital malformation ,

post-inflammatory ,post- hemorrhagic and mass

lesion

2- Communicating : Due to overproduction ofC.S.F, defective absorption of C.S.F. and

insufficiency of venous drainage .


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BRAIN TUMERS

A- Supratentorial:

1- Meningioma: Supposed to be arise from

arachnoidal tissue and frequently near the venous

sinuses it has a tendency to become calcified

(psammoma) this type of tumors characteristically

infiltrates the skull but compress the brain .

The common site of tumors is :


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1-Parasagital areas

2-Lateral surface of temporal lobe

3-Sphinoidal ridge

4-Olfactory groove

5-Suprasellar

6-Cerebropontin angle


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2- Craniopharyngioma: Arise from congenital

remnants of rasthke`s pouch common site issuprasellar and age of onset 10-30 Y

3- Cholesteatoma: It is epidermoid which arises from

congenital remnants of cells the common site

cerebropontinangel (C.P.A) and temporal lobe

4- Astrocytoma: (most common glioma) It arise fromastrocyte the cerebellum common site in children and

cerebral hemisphere in adult .


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5- Oligodendroglioma: Rare type of glioma and

occipital lobe its common site

6- Ependymoma: Aris from ependymal cell its

common site vermis of cerebellum and floor of fourth

ventricles lead to increase I,C.T

7- Glioblastoma multiform : Highly malignant

glioma it common site cerebral hemisphere and rare

in the occipital region.


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8- Spongioblastoma polar: Pones and opticchiasma are the common sits

9- Pineal body tumors : Midbrain is the common

sit lead to endocrinal disturbances

10-Tumors of pituitary gland .


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B- Infratentorial tumors:

1- Medulloblastoma: Occure mostly in children

before age of 10 years it arises from

undifferentiated cell rests in the vermis or in the

posterior modularly velum which form the roof of

the fourth ventricle ,lead to increase intracranial

tension and ataxia


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2-Cerebellar astrocytoma: located in the

cerebellar hemisphere when it occurs in children

3-Cerebellar angioblastoma: Arises from

embryonic vascular cells and it is frequently

located on one cerebellar hemisphere .


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4- Acoustic neuroma: Commonly located in

cerebello- pontin angle which a benign tumor arises

from the sheath of the vestibular branch of the

auditory nerve inside the internal auditory meatus.

The tumor may occur in middle age when it is usually

single or it may develop in young age when it is

frequently multiple .


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Clinical diagnosis of tumors

General:

1- Headache: It is the first symptom in 35% of

patients and occurs later in 70% morning

headache or those that waken the patients from

sleep.


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2- Vomiting or nausea: Due to increase I.C.P

involvement of the chemoreceptor trigger zone in

the medulla may lead to projectile vomiting.

3- Facial pain: Due to distribution of the trigeminal

nerve with tumors at the base of the skull.


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4- Seizures: Are the first symptom in 30%of brain

tumors and brain tumors account for only 5% of all

patients with epilepsy. Slowly growing tumors and

those in the rolandic fissure tend to be the most

epileptogenic. The association between brain

tumors and seizures increase with age.

5- Alteration in consciousness : May be evident

in 20% of patients at the time of diagnosis and

vary from subtle personality changes to confusion

to coma.


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Focal symptoms and signs :

1- Frontal lobe: Are initially silent, with time there

may be personality change, impaired judgment

and gait abnormalities.

2-Temporal lobe : Seizure which range from

simple olfactory hallucination, feeling of fear tocomplex partial seizure.


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3- Parietal lobe:loss cortical sensation and

hemiparesis .

4- Occipital lobe : Visual field change .

5-Thalamic: Contralateral sensory loss, cognitive

changes and rarely aphasia .

6- Brain stem: Cranial nerve disturbances .


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7- Pineal body: Signs and symptoms of increase

I.C.P. and precocious puberty

8- Intraventricular: Hydrocephalus and increase

I.C.P.9- Cerebellar: Headache and ataxia.

10- Skull base: Affect cranial nerve


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False localizing signs :

may arise from increase I.C.P. the most common is :

1- Sixth cranial nerve due to compression of

abducent nerve over petrous ridge.

2- Ipsilateral hemiparesis: Due to compression of

contralateral cerebral peduncle against tentorium .


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3- Bitemporal hemianopia: Due to compression

optic chiasma at lateral side

4- Giat abnormalities

5- Endocrinal deficit


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Diagnosis:

Careful history and neurological examination,C.T scan & brain M.R.I with & without contrast.

Treatment:

Surgical resection partial or complete

radiotherapy and or chemotherapy.


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brain tumors د.عبدالرحمن سلام

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