Diagnosis and Treatment of Brain TumorsBrain Tumors A brain tumor is a mass of unnecessary, and abnormal, cells growing in the brain. Tumors may be benign, malignant, arise from within the brain, its coverings, or metastasize from another location in the bodyNeurologic Diagnosis Where is it? Signs and Symptoms What is it? TempoTypes of Tumors Benign Meningeal - covering of brain Nerve lining Pituitary Bone/Cartilage Malignant Primary CNS MetastaticIncidence 186,000 diagnosed in 2002 in USA 36,400 primary (12.73/100,000) 150,000 metastatic (10-15% of cancer) Prevalence (primary) benign - 100/100,000 malignant - 30/100,000Statistics Second most common malignancy of childhood, most common solid tumor Second leading cause of cancer related deaths in males age 20-40 Fifth leading cause of cancer related deaths in women age 20-40Cerebrum and CerebellumCranial Nerves - BaseGeneralized symptoms and sign = Symptoms of increased intracrainal pressure mechanismIncreased Intracranial Pressure HeadacheHeadaches are a common initial symptom. Typical “brain tumor headaches“ are often described as worse in the morning, with improvement gradually during the day. They may rouse the person from sleep. Sometimes, upon awakening, the person vomits then feels better. These headaches may worsen with coughing, exercise, or with a change in position such as bending or kneeling. They also do not typically respond to the usual headache remedies. Nausea/Vomiting Papilledema Lethargy Mental and/or Personality ChangesThese can range from problems with memory (especially short-term memory), speech, communication and/or concentration changes to severe intellectual problems and confusion. Changes in behavior, temperament and personality may also occur, depending where the tumor is located. These changes can be caused by the tumor itself, by increased pressure within the skull caused by the presence of the tumor, or by involvement of the parts of the brain that control personality. Double vision SeizureSeizures are a common symptom of a brain tumor. Seizures are caused by a disruption in the normal flow of electricity in the brain. Those sudden bursts of electricity may cause convulsions, unusual sensations, and loss of consciousness. Focal seizures - such as muscle twitching or jerking of an arm or leg, abnormal smells or tastes, problems with speech or numbness and tingling - may also occur.Focal symptoms and sign 局灶症状和体征 are due to a tumors effect on specific brain structures. are useful to indentify the location of brain tumor1 Brain Stem - the Midbrain, Pons, Medulla n muscle weaknessn drooping eyelidndifficulty in swallowingn double visionThe posterior fossa ncontains the fourth ventricle, cerebellum and brain stem. na clumsy, uncoordinated walk, swaying, and staggering might occurndizziness, tremors, as well as difficulty with speech, are also frequent symptomsExample: ependynomas 室管膜瘤 P139most often occur in children and adolescent.the fourth ventricle is the most common siteslow-growing but 脑积水 are often occured Example: medulloblastomas 髓母细胞瘤P139Is the most comman brain tumor of childhoodIs a small-cell neuroectodermal tumor of the cerebellumAre highly malignant, have a propensity to seed thoughout the CSFAre highly radiosensitive Cerebellopontine Angle the earliest symptom of a tumor is ringing or buzzing in the ear. as a tumor grows, deafness, loss of facial sensation and/or facial weakness can occur other symptoms are similar to those of a brain stem tumor.Example: Acoustic neuroma P141This benign tumor originate from the eighth nerves.usually grow slowly and can take years to develophearing loss and a ringing (tinnitus) in the affected ear vertigo and balance difficulties If untreated , it can press against other nerves in the region and cause other symptoms. Example: epidermiod cyst表皮样囊肿P142This benign tumor belongs to congenital tumor.Often occur in the cerebellopontine angel and the basal cisternsThe capsule is frequently adherent to adjacent cranial nerves and vascular structure MRI studies are very useful, Frontal Lobe the frontal lobe ocontrols voluntary movement, usually on the opposite side of the body. the frontal lobe of the dominant hemisphere controls language and writing. one-sided paralysis, prlisis seizures, short-term memory loss, personality or mental changes. Example: oligodendrogliomas 少突胶质细胞瘤P138 Occur often in the frontal lobe Are associated with a long history of seizures Many have mineralization,which is visible on CT. Low-grade5 Temporal Lobe the temporal lobe is involved in the understanding of sounds and spoken words, as well as emotion and memory. seizures are the most common symptom of a tumor in this location. the ability to recognize sounds or the source of sounds may be affected. vision can be impaired.Exam