CNS Tumors

CNS Tumors

1. Types of tumors

   • Metastatic
     • Lung Breast Kidney
   • Primary
     • Adults
       • Glioblastoma multiforme
         • Malignant, high-grade tumor of astrocytes
         • Poor prognosis
         • GFAP positive
       • Meningioma
         • Benign tumor of arachnoid cells
         • May present as seizures; tumor compresses, but does not invade, the cortex
       • Oligodendroglioma
         • Malignant tumor of oligodendrocytes
         • Imaging reveals a calcified tumor in the white matter, usually involving the frontal lobe
         • Fried-egg appearance of cells on biopsy
     • Children
       • Pilocytic astrocytoma
         • Benign tumor of astrocytes
         • Imaging reveals a cystic lesion with a mural nodule
       • Ependymoma
         • commonly arises in the 4th ventricle; may present with hydrocephalus
         • Perivascular pseudorosettes are a characteristic finding on biopsy
       • Medulloblastoma
         • Malignant tumor derived from the granular cells of the cerebellum (neuroectoderm)
         • Homer-Wright rosettes may be present
         • Metastasis to the cauda equina is termed 'drop metastasis

2. The Eye

   • Fundoscopic examination
     • Red Reflex
       • Shine the light beam on the pupil from a position about 15 inches away from the patient
         • note any opacities interrupting the red reflex
     • Optic disc
       • -margins are sharp color -yellowish orange to creamy pink shape- round or oval Cup to disc ratio: less than half
     • Blood vessels
       • -vessels sizes -character of A-V crossings
     • Retina
     • Macula
   • Anatomy of the orbit

3. Stereognosis

   • ability to recognize objects using only tactile (somatic) sensation
     • Patients suffering from dementia may show astereognosis

4. Prognosis

   • five-year survival rate for malignant brain tumours is 35 %
   • Malignant brain and other CNS tumours are the most common cause of cancer death in children up to age 14 years

5. Management of brain tumors

   • treatments include brachytherapy, intensity-modulated radiation therapy (IMRT) and radiosurgery
     • radiation therapy uses external beams of x-rays, gamma rays or protons
       • Can also use Chemotherapy along with radiation
         • Surgery
           • Craniotomy
           • Awake craniotomy

6. Diagnosis

   • Neurologic examination
   • MRI
   • CT scan
   • Angiogram
   • Spinal tap
   • Biopsy
   • Biomarkers
     • 1p/19q co-deletion test
       • Oligodendrogliomas
     • IDH1 and IDH2 mutation test
       • Gliomas
     • BRAF
       • Biomarker for this tumor

7. Headaches

   • Primary
     • -Migraine -Tension-type Headache -Cluster headache
   • Secondary
     • -Post-traumatic -Vascular -Nonvascular intracranial disorder -Substance related -Non-cephalic infection

Images and files in the map