Brain Tumors

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 Brain Tumors
Adults Pediatrics
• Metastasis • Pineal Gland Tumor
• Glioblastoma Multiforme • Craniopharyngioma
• Meningioma • Pilocytic Astrocytoma
• Acoustic Neuroma • Medulloblastoma
• Pituitary Adenoma • Ependymoma
• Oligodendroglioma

Common Features
• Early morning headache
• Worse w/ bending over/Valsalva
• Symptoms of ↑ ICP (Headache, Papilledema, N/V)
• Dx: MRI w/ contrast
• Mgmt: +/- Surgery, +/- Radiation, +/-
Chemotherapy

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 Metastasis
• Presentation: Patient with a histor y of cancer
• Headache
• Seizures
• +/- Focal deficit
• #1 brain malignancy in adults

• Pathophysiology: Hematogenous spread

• Lung, Breast, Kidney, Melanoma, Gastrointestinal

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 Metastasis
• Dx: MRI w/ contrast => Grey-white matter junction

• Mgmt: Radiation +/- Surgery

• Chemotherapy specific to 1˚ cancer
• Glucocorticoids to ↓ ICP

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 Glioblastoma Multiforme
• Presentation: Headache, seizures, +/- focal deficit
• Highly aggressive (days to weeks)

• Pathophysiology: GFAP +

• Dx: MRI w/ contrast => Crosses Corpus Callosum

• Mgmt: Surgery + Radiation + Temozolomide

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 Meningioma
• Presentation: Older female w/ headache, seizures, +/- focal deficit
• If parasagittal and anterior => Lower extremity motor loss

• Pathophysiology: Benign neoplasm of arachnoid cells

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 Meningioma
• Dx: MRI w/ contrast => Extra-axial mass w/ a “dural tail”
• CT => Hyperostosis of the skull

• Mgmt: If ≤2 cm and asymptomatic => MRI in 3 months

• If >2 cm OR symptomatic => Surgery + Radiation

CC (0): Public Domain

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 Acoustic Neuroma
• Presentation: Sensorineural hearing loss (unilateral or bilateral)
• +/- Vertigo
• If CN VII => Facial “droop”
• If CN V => Facial sensory loss

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 Acoustic Neuroma
• Pathophysiology: Neoplasm of Schwann cells of CN VIII
• If bilateral => Neurofibromatosis 2 (NF 2)

• Dx: MRI w/ contrast => Cerebellopontine angle

• Mgmt: Surgery +/- Radiation

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Pituitary
Adenoma

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 Pituitary Adenoma
• Presentation: Morning headaches, galactorrhea
• Impotence, amenorrhea, galactorrhea, ↓ facial hair
• Bitemporal hemianopsia
(also seen in Craniopharyngioma, Anterior Comm. Artery aneurysms)

• Pathophysiology: Benign neoplasm of pituitary gland (MEN 1)

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 Pituitary Adenoma
• Dx: MRI + Labs (Prolactin, GH, TSH, 24-hour urine free cortisol)
• If <1 cm => “Microadenoma”
• If ≥1 cm => “Macroadenoma”

• Mgmt: If <1 cm and asymptomatic => Repeat MRI + Labs in 1 year

• If ≥1 cm, functioning adenoma, or visual field deficits => Surgery
• If Prolactinoma => D2 agonist (e.g. Bromocriptine)

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 Oligodendroglioma
• Presentation: Headache, seizures, +/- focal deficit
• Progresses slowly (years)

• Pathophysiology: Isocitrate dehydrogenase (IDH) mutation

• Chromosomes 1 and 19

• Dx: MRI w/ contrast => +/- Calcifications

• Mgmt: Surgery + Radiation

• Chemotherapy

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