Brain Tumors

Faisal Alotaibi
• To appreciate the spectrum of common brain
tumours, their presenta3on, inves3ga3on and
treatment
• To recognise common presenta3ons of
intracranial infec3on, and know the principles of
management
Epidemiology
Classification-types
Adult
Pediatric
Epidemiology

Incidence: 8-25/ 100.000

Metastasis: 25%

Primary brain tumours represent 1.5 per cent of all cancers, with an incidence
 E=ology

Predisposition factors

Gene.cs: Neurofibromatosis Viral infection:

Epstein-Barr virus: Lymphoma

Environmental factors
Ves3bular
schwannoma • Chemicals
• Toxins
• Radiation
Classifica=on

1.Tumors of neuroepithelial =ssue

2.Tumors of cranial and paraspinal nerves
3.Tumors of the meninges
4.Lymphomas and hematopoie=c neoplasms
5.Germ cell tumors
6.Tumors of the sellar region
7.Metasta=c tumors

• Intra-axial
• Extra-axial
Intra-axial

Extra-axial
Presenting Symptoms

Progressive neurologic deficit (68%)

Headache (increased ICP): 54%

Seizures: 26%
Glioma

Astrocytoma (Glioma)

Astrocytic tumors are the most

common primary intra-axial brain
tumor

Incidence: 5.17 per 100,000

4 Grades

Grade I: Benign
Grade II: Intermediate
Grade III & IV Malignant

Glioblastoma is the most malignant type

Glioma

Rim Enhancement
(Ring enhancement)
Glioma

Glioblastoma mul3forme Abscess

Irregular thick margins Smooth thin margins

Glioma

Malignant glioma

• 1 gram of tumor = one billion cells

• GTR = removal of 99% (990,000,000 cells)
• Still have 10,000,000 tumor cells
• Radiation leaving 100,000 cells

Need chemotherapy
GTR: Gross Total Resection
Meningioma

Mostly benign

Originate from the arachnoid

Attached to dura: Dural tail sign

Pineal region tumor

Germinoma

Usually present with:

obstructive
hydrocephalus

Parinuad’s syndrome
Pituitary Adenoma

Presenta(on:

Endocrinopathy

Visual field defect

bitemporal hemianopia
Posterior fossa

Common in children

Presentations:
Cerebellar signs
Cranial nerve dysfunction (6th and 7th)
Obstructive hydrocephalus

DDx:

Medulloblastoma
Pilocytic astrocytoma
Ependymoma
Brain Metasta=c Tumors

Lung origin is the commonest Severe vasogenic edema

Mul@ple Single Metastasis

Colloid cyst

Located at anterior third ventricle at foramen of monro

Presenta(ons:

Headache Posi@onal
Sudden death 10%

Urgent surgical interven@on

in symptoma@c colloid cyst
Epidermoid tumor

“Pearly tumor”
Brain Infections
Infec=ons
Presentations:

• Meningitis
Bacterial
Viral • Space occupying lesion(Mass effect):
Fungal Headache,
Neurological deficit
TB
Other Factors:

• Sinusi@s
• O@@s media
• Skull fractures and CSF leak
• Procedures
• Immunodeficiency-compromised
Infec=ons

Meningitis

CSF Analysis
Bacterial
High WBC
Low Glucose

Normal Glucose Viral and others

Lymphocytosis

Suspected meningitis: Start empirical antibiotics

Infec=ons

Brain Abscess
Pathogenesis:
Bacterial

Streptococcus (aerobic and anaerobic) Direct 50%

most common (30-50%) Blood
Trauma
Fungal Surgical
Immunocompromized
TB

Others: eg. Parasi(c (hydated

cyst)
Infec=ons

Stages of brain abscess

• Early cerebritis
• Late cerebritis
• Early capsule
• Late capsule

Surgical indica,ons: Blood culture:

Usually negative
• Diagnos3c
• Mass effects
• Proximity to ventricle Procedure
Aspira3on
Infections

Fungal
Pathogenic: capable of infec.ng a healthy host.
Coccidioides immi.s
Histoplasma capsulatum
Blastomyces derma.dis

Opportunis;c: usually produce infec.on only in immunocompromised host

Nocardia
Aspergillus
Candida
Mucor
Infec=ons

Fungal

Treatment Goals In CNS Fungal Disease:

Subdural, epidural, or intraparenchymal lesions must be

excised or drained.

hydrocephalus should be treated

Antifungal agents
Infec=ons

Tuberculosis
Daughter cyst

Meningitis
Tuberculoma Abscess

Best test
TB PCR (Polymerase chain reaction)
Infections

Other infec;ons
ECHINOCOCCOSIS Hydated cyst Dog tapeworm Echinococcus Granulosa.

Anti-microbial: Albendazole
Infec=ons

NEUROCYSTICERCOSIS

larval stage (“cys3cercus cellulose”)of the pork tapeworm taenia solium

Anti-microbial: Albendazole
Ques=ons

Which of the following is the must common metastatic brain tumor?

A. Breast cancer
B. Lung small cell tumor
C. Colon adenocarcinoma
D. Hepatocellular cercinoma
Questions

A 26-year-old man who presented with headache and vomiting over 3 weeks.
Examination revealed papilloedema, right 6th nerve palsy, truncal-limbs ataxia, and
limbs dysmetria.

CT brain: Intracranial mass lesion

Which of the following is the most likely location of this lesion?

A. Frontal
B. Cerebellar
C. Suprasellar
D. Parietooccipital
Ques=ons

A 4-month-old baby boy who present to emergency room with projec.le vomi.ng and
inac.vity.
Examina.on: Tense anterior fontanelle, dilated scalp veins, and hypotonia.

CT brain: Posterior fossa tumor and acute hydrocephalus

Which of one the following is considered the likely differen.al diagnosis?

A. Meningioma
B. Colloid cyst
C. Germinoma
D. Medulloblastoma
Treat hydrocephalus
Baily and Love’s Book