Brain Tumors

Brain Tumors

1. Differential Diagnosis of Double Vision

   • Lens Problems
     • Cataract
   • Cornea Problems
     • Astigmatism\Dry eyes syndrome\Infections
   • Eye Muscle Problems
     • Strabismus\ Graves disease
   • Nerve problem
     • Diabetes\Myasthenia gravis \MS\ Guillain Barre syndrome
   • Brain problems
     • Brain tumors\Migraine\Increased ICP

2. Differential Diagnosis of Vomiting

3. Differential Diagnosis of Limb Weakness

4. Anatomy of orbit

   • Anatomy of extraocular muscles

5. The Visual Pathway

   • 1st order neuron
     • its cell bodies lie in the retina (ganglion cells)
       • their axons form the optic nerve, optic chiasma & optic tract.
         • their axons form the optic nerve, optic chiasma & optic tract.
   • 2nd order neuron
     • its cell bodies lie in the L.G.B
       • their axons form the optic radiation that terminate in the visual cortex of the occipital lobe of the brain

6. Types of speech

   • Apraxia of speech
     • and involves inconsistent production of speech sounds and rearranging of sounds in a word
   • Cluttering
     • a rapid rate of speech, which makes speech difficult to understand.
   • Dysarthria
     • is a weakness or paralysis of speech muscles
   • Dysprosody
     • It is characterized by alterations in intensity, in the timing of utterance segments, and in rhythm, cadence, and intonation of words.
   • Muteness
     • is complete inability to speak
   • Speech Sound Disorders
     • involve difficulty in producing specific speech sounds
   • Stuttering
   • Voice disorders
     • are impairments, often physical, that involve the function of the larynx or vocal resonance

7. Clinical presentation

8. Risk Factors of Brain Tumors

   • Age\Gender\Home & Work Exposures\Family History\Exposure to infections, viruses and allergens\Electromagnetic fields \Race and ethnicity\Ionizing Radiation\Head Injury & Seizures

9. Types of brain tumors

   • Adults tumors
     • primary tumors are usually supratentorial.
     • glioblastoma multiforme
       • Malignant, high-grade tumor of astrocytes
       • Most common primary malignant CNS tumor in adults
       • Usually arises in the cerebral hemisphere; characteristically crosses the corpus callosum
       • Butterfly lesion
       • Histology
         • Characterized by regions of necrosis surrounded by tumor cells (pseudopalisading) and endothelial cell proliferation; tumor cells are GFAP positive.
       • Poor prognosis
     • schwannoma
       • Benign tumor of Schwann cells
       • involves cranial or spinal nerves; within the cranium, most frequently involves cranial nerve VIII at the cerebellopontine angle (presents as loss of hearing and tinnitus)
       • Tumor cells are S-100 positive.
       • Histology
       • prognosis
         • Good prognosis after resection
     • meningioma
       • Benign tumor of arachnoid cells
       • Most common benign CNS tumor in adults
         • More commonly seen in women; rare in children
       • May present as seizures; tumor compresses, but does not invade, the cortex.
       • Imaging reveals a round mass attached to the dura.
       • Histology
         • shows a whorled pattern; psammoma bodies may be present.
       • Prognosis
         • Good prognosis
           • Grade 1
             • 93%
           • Grade 2
             • 5%
           • Grade 3
             • 2%
   • Children tumors
     • primary tumors are usually infra tentorial
     • pilocytic astrocytoma
       • Benign tumor of astrocytes
       • Most common CNS tumor in children; usually arises in the cerebellum
       • Imaging reveals a cystic lesion with a mural nodule
       • Histology
         • Biopsy shows Rosenthal fibers (thick eosinophilic processes of astrocytes) and eosinophilic granular bodies; tumor cells are GFAP positive.
       • Grading
     • ependymoma
       • Malignant tumor of ependymal cells
       • Most commonly arises in the 4th ventricle; may present with hydrocephalus
       • Histology
         • Perivascular pseudorosettes are a characteristic finding on biopsy
       • Prognosis
         • Recur after surgery, acquire more aggressiveness
           • Prognosis depends on the location and its histologic grade.
     • medulloblastoma
       • Malignant tumor derived from the granular cells of the cerebellum (neuroectoderm)
       • Histology
         • Histology reveals small, round blue cells; Homer-Wright rosettes may be present.
       • Poor prognosis; tumor grows rapidly and spreads via CSF.
         • Metastasis to the cauda equina is termed 'drop metastasis
       • Prognosis
         • Resection & radiation allow 5-year survival of 75%.
   • Metastatic Brain tumors
     • Breast\Lung\Skin\Kidney\GIT
   • Other tumors
     • OLIGODENDROGLIOMA
       • Malignant tumor of oligodendrocytes
       • Imaging reveals a calcified tumor in the white matter, usually involving the frontal lobe; may present with seizures
       • Histology
         • 'Fried-egg' appearance of cells on biopsy
       • prognosis
         • Slow-growing, long survival (5-10 yrs)
         • Grade 2 (with treatment): 10-20 years
         • Grade 3 (with treatment): 5-10 years
         • 5-year survival rate is 75%, 10-year survival rate is 50%.

10. Investigations of space occupying lesions of the brain

11. Eye Examination

12. Risks of Brain Surgery

    • Allergic reaction to anesthesia\Bleeding in the brain\A blood clot\Brain swelling\Coma\Impaired speech, vision, coordination, or balance\Infection in the brain or at the wound site\Memory problems\Seizures\Stroke

13. Brain tumor grading system

14. Management plan

    • Consider

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