BRAIN TUMORS:

Epidemiology:82/100000 20% of malignancies of<15 years

Incidence peak in childhoodincrease 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-incontinency-

Primitive reflexes

Occiputal SOL:Visual field changes

Temporal SOL: Seizure-Aphasia-

Visual field disturbance

Parietal SOL: Cortical sensoryloss

Neglect-Anosognosis-

Hemiparesis-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-vertigoPituitary adenoma: Bitemporal hemianopia

Neuroophthalmologic signs:

Parinaud syn.-Ptosis-papiledema-

Optic atrophy-Foster kennedy syn.

Laboratory Findings:

Skull x ray-Brain CT scan&MRI-

Angiography-MRA-PET&SPECT

Evoked potentials-EEG

D.D: Stoke-Infection-MS-Sarcoidosis

meningiomas: F>M-6th&7th decade-

childhood(rarely)-90% intracranial

Ethiology; Radiation-Trauma?-

progestrone-Viral

Clinical Manifestations: Seizure-

Hemiparesis-cranial palsy-IICP

Imaging:x ray-CT-MRI-MRA

Treatment:Resection-Radiothrapy-

Proton beam- Mifepristone(RU486

-Chemothrapy(Ifosfamide)-AEDsGliomas:60%primary brain tumors

low grade- high grade

<25 years67% infratentorial

>25years 90% supratentorial

Location: white matter (frontal-temporal-frontoparietal)

Symptoms: Seizure-focal deficits- Memmory& personality disturbance

Treatment: Resection-radiation-chemotherapy (carmustin& procarbazin)

Oligodendroglioma: Sensitive to

chemothrapy-5% SOL-50YEARS

Symptoms: Seizure-focal deficit

Imaging: Hypodensity-calcification

Treatment: Resection –Radiation-

Chemothrapy(PCV-CCNU)

Ependymoma:3-5years-vomiting

Hydrocephalus

Location: Ventricles-spinal cord

Treatment: Resection-Radiation

PNET: Childhood-Mitosis-Invasive

Medulloblastoma: Vermis

Treatment: Mixed thrapy

;

Brain MetastasisThe most common direct neurological complication of

Systemic cancer

BM>primary malignant brain tumor 10 times

Prostate cancer 1%BM ovarian cancer 3% BM

Melanoma 18-90%BM lung cancer 18-63%

;

Breast cancer 20-30%BM20-40% 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-choriocarcinoma-

thyroid &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%)- IICP-

pappiledema(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-dementia

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 M>F 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

;

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 reflexSpinal 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 root- or bladder dysfunctionRarely the only manifestation of cord compression is a gait disorder(sensory ataxia or spinocerbellar)

;

Lung-breast-GI-prostate-melanoma=>80% of original siteTreatment is palliativeLoss of bladder or bowel is anOminous prognostic sign and isUsually irreversibleRadiotherapy is treatment of Choice melanoma_surgical T

;

Intramedullary metastasis: The most common sites :lung or breast 60% multiple metastasisDeath 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