Bahan Lapsus Brain Tumor

8/12/2019 Bahan Lapsus Brain Tumor

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ymptoms of solid neoplasms of the brain (primary brain tumors and secondary tumors

alike) can be divided in main categories*

/onse0uences of intracranial hypertension* The symptoms that often occur first

are those that are the conse0uences of increased intracranial pressure* 1argetumors or tumors with e&tensive perifocal swelling (edema) inevitably lead to

elevated intracranial pressure(intracranial hypertension), which translates clinically

into headaches, vomiting(sometimes without nausea), altered state

of consciousness(somnolence, coma), dilation of the pupil on the side of the lesion

(anisocoria),papilledema(prominent optic discat the funduscopic eye e&amination).

!owever, even small tumors obstructing the passage of cerebrospinal fluid(/2)

may cause early signs of increased intracranial pressure. #ncreased intracranial

pressure may result in herniation(i.e. displacement) of certain parts of the brain,

such as the cerebellar tonsilsor the temporal uncus, resulting in

lethal brainstemcompression. #n very young children, elevated intracranial pressure

may cause an increase in the diameter of the skulland bulging of the fontanelles.

3ysfunction* depending on the tumor location and the damage it may have

caused to surrounding brainstructures, either through compression or infiltration,

any type of focal neurologic symptomsmay occur, such

as cognitiveand behavioralimpairment (including impaired 4udgment, memory loss,

lack of recognition, spatial orientation disorders), personalityor emotional

changes,hemiparesis, hypoesthesia, aphasia, ata&ia, visual fieldimpairment,impaired sense of smell, impaired hearing, facial paralysis,double vision, di$$iness,

but more severe symptoms might occur too such as* paralysis on one side of the

bodyhemiplegiaor impairment to swallow . These symptoms are not specific for

brain tumors + they may be caused by a large variety of neurologic conditions

(e.g.stroke, traumatic brain in4ury). What counts, however, is the location of the

lesion and the functional systems (e.g.motor, sensory, visual, etc.) it affects. A

bilateral temporal visual fielddefect (bitemporal hemianopia5due to compression of

theoptic chiasm), often associated with endocrine dysfunction5

eitherhypopituitarismor hyperproduction of

pituitaryhormonesandhyperprolactinemiais suggestive of a pituitary tumor.

#rritation* abnormal fatigue, weariness, absences and tremors, but also epileptic

sei$ures.
http://en.wikipedia.org/wiki/Intracranial_hypertensionhttp://en.wikipedia.org/wiki/Edemahttp://en.wikipedia.org/wiki/Intracranial_pressurehttp://en.wikipedia.org/wiki/Headacheshttp://en.wikipedia.org/wiki/Vomitinghttp://en.wikipedia.org/wiki/Nauseahttp://en.wikipedia.org/wiki/Consciousnesshttp://en.wikipedia.org/wiki/Somnolencehttp://en.wikipedia.org/wiki/Comahttp://en.wikipedia.org/wiki/Anisocoriahttp://en.wikipedia.org/wiki/Papilledemahttp://en.wikipedia.org/wiki/Papilledemahttp://en.wikipedia.org/wiki/Optic_dischttp://en.wikipedia.org/wiki/Cerebrospinal_fluidhttp://en.wikipedia.org/wiki/Herniationhttp://en.wikipedia.org/wiki/Cerebellar_tonsilshttp://en.wikipedia.org/wiki/Uncushttp://en.wikipedia.org/wiki/Brainstemhttp://en.wikipedia.org/wiki/Human_skullhttp://en.wikipedia.org/wiki/Fontanellehttp://en.wikipedia.org/wiki/Human_brainhttp://en.wikipedia.org/wiki/Focal_neurologic_symptomhttp://en.wikipedia.org/wiki/Cognitivehttp://en.wikipedia.org/wiki/Behavioralhttp://en.wiktionary.org/wiki/personalityhttp://en.wikipedia.org/wiki/Hemiparesishttp://en.wikipedia.org/wiki/Hypoesthesiahttp://en.wikipedia.org/wiki/Aphasiahttp://en.wikipedia.org/wiki/Ataxiahttp://en.wikipedia.org/wiki/Visual_fieldhttp://en.wikipedia.org/wiki/Facial_paralysishttp://en.wikipedia.org/wiki/Diplopiahttp://en.wikipedia.org/wiki/Dizzinesshttp://en.wikipedia.org/wiki/Dizzinesshttp://en.wikipedia.org/wiki/Hemiplegiahttp://en.wikipedia.org/wiki/Hemiplegiahttp://en.wikipedia.org/wiki/Strokehttp://en.wikipedia.org/wiki/Traumatic_brain_injuryhttp://en.wikipedia.org/wiki/Visual_fieldhttp://en.wikipedia.org/wiki/Bitemporal_hemianopiahttp://en.wikipedia.org/wiki/Optic_chiasmhttp://en.wikipedia.org/wiki/Hypopituitarismhttp://en.wikipedia.org/wiki/Hypopituitarismhttp://en.wikipedia.org/wiki/Hormoneshttp://en.wikipedia.org/wiki/Hormoneshttp://en.wikipedia.org/wiki/Hyperprolactinemiahttp://en.wikipedia.org/wiki/Tremorhttp://en.wikipedia.org/wiki/Epilepsyhttp://en.wikipedia.org/wiki/Epilepsyhttp://en.wikipedia.org/wiki/Intracranial_hypertensionhttp://en.wikipedia.org/wiki/Edemahttp://en.wikipedia.org/wiki/Intracranial_pressurehttp://en.wikipedia.org/wiki/Headacheshttp://en.wikipedia.org/wiki/Vomitinghttp://en.wikipedia.org/wiki/Nauseahttp://en.wikipedia.org/wiki/Consciousnesshttp://en.wikipedia.org/wiki/Somnolencehttp://en.wikipedia.org/wiki/Comahttp://en.wikipedia.org/wiki/Anisocoriahttp://en.wikipedia.org/wiki/Papilledemahttp://en.wikipedia.org/wiki/Optic_dischttp://en.wikipedia.org/wiki/Cerebrospinal_fluidhttp://en.wikipedia.org/wiki/Herniationhttp://en.wikipedia.org/wiki/Cerebellar_tonsilshttp://en.wikipedia.org/wiki/Uncushttp://en.wikipedia.org/wiki/Brainstemhttp://en.wikipedia.org/wiki/Human_skullhttp://en.wikipedia.org/wiki/Fontanellehttp://en.wikipedia.org/wiki/Human_brainhttp://en.wikipedia.org/wiki/Focal_neurologic_symptomhttp://en.wikipedia.org/wiki/Cognitivehttp://en.wikipedia.org/wiki/Behavioralhttp://en.wiktionary.org/wiki/personalityhttp://en.wikipedia.org/wiki/Hemiparesishttp://en.wikipedia.org/wiki/Hypoesthesiahttp://en.wikipedia.org/wiki/Aphasiahttp://en.wikipedia.org/wiki/Ataxiahttp://en.wikipedia.org/wiki/Visual_fieldhttp://en.wikipedia.org/wiki/Facial_paralysishttp://en.wikipedia.org/wiki/Diplopiahttp://en.wikipedia.org/wiki/Dizzinesshttp://en.wikipedia.org/wiki/Hemiplegiahttp://en.wikipedia.org/wiki/Strokehttp://en.wikipedia.org/wiki/Traumatic_brain_injuryhttp://en.wikipedia.org/wiki/Visual_fieldhttp://en.wikipedia.org/wiki/Bitemporal_hemianopiahttp://en.wikipedia.org/wiki/Optic_chiasmhttp://en.wikipedia.org/wiki/Hypopituitarismhttp://en.wikipedia.org/wiki/Hormoneshttp://en.wikipedia.org/wiki/Hyperprolactinemiahttp://en.wikipedia.org/wiki/Tremorhttp://en.wikipedia.org/wiki/Epilepsyhttp://en.wikipedia.org/wiki/Epilepsy


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The above symptoms are true for A11 types of neoplasm of the brain (including

secondary tumors). #t is common that a person carriesa primary benign neoplasm for

several years and have no visible symptoms at all. 6any present some uncertain and

intermittent symptoms like headaches and occasional vomiting or weariness, which can

be easily mistaken for gastritisor gastroenteritis. #t might seem strange that despite

having a mass in his skull e&ercising pressure on the brain the patient feels no pain, but

as anyone who has suffered a concussion can attest, pain is felt on the outside of

the skulland not in the brain itself. The brain has no nerve sensors in the meninges

(outer surface) with which to feel or transmit pain to the brain7s pain center" it cannot

signal pain without a sensory input. That is why secondary symptoms like those

described above should alert doctors to the possible diagnosis of a neoplasm of the

brain.

#n a recent study by the 3utch 8' Association, a list of causes of headaches 9:;waspublished, that should alert 8'7s to take their diagnosis further than to choose for

symptomatic treatment of headaches with simple pain medication (note the occurrence

of brain tumors as possible cause)*

Alarm signals Possible cause

First headache complaint from person

over 50 years old

brain tumor, arteritis temporalis

First migraine attack in person over 40years old

brain tumor

Headache in person under 6 years old brain tumor, hydrocephalus

Person over 50 years old ith pain at

temples!iant"cell arteritis

Pregnancy ith unknon headache pre"eclampsia

#ncreased headaches after trauma sub$epidural hematoma
http://en.wikipedia.org/wiki/Gastritishttp://en.wikipedia.org/wiki/Gastroenteritishttp://en.wikipedia.org/wiki/Skullhttp://en.wikipedia.org/wiki/Brain_tumor#cite_note-1http://en.wikipedia.org/wiki/Giant-cell_arteritishttp://en.wikipedia.org/wiki/Hydrocephalushttp://en.wikipedia.org/wiki/Giant-cell_arteritishttp://en.wikipedia.org/wiki/Headachehttp://en.wikipedia.org/wiki/Pre-eclampsiahttp://en.wikipedia.org/wiki/Hematomahttp://en.wikipedia.org/wiki/Gastritishttp://en.wikipedia.org/wiki/Gastroenteritishttp://en.wikipedia.org/wiki/Skullhttp://en.wikipedia.org/wiki/Brain_tumor#cite_note-1http://en.wikipedia.org/wiki/Giant-cell_arteritishttp://en.wikipedia.org/wiki/Hydrocephalushttp://en.wikipedia.org/wiki/Giant-cell_arteritishttp://en.wikipedia.org/wiki/Headachehttp://en.wikipedia.org/wiki/Pre-eclampsiahttp://en.wikipedia.org/wiki/Hematoma


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%evere headaches and very high bloodpressure

malignant hypertension

&cute severe headache meningitis,'(&)'erebrovascular accident orstroke*, subarachnoidal hemorrhage

Headache and fever )ith reducedconsciousness*

meningitis

%tiffness of the neck$neurologicaldysfunction

meningitis, brain tumor

Headache ith signs ofelevatedintracranial pressure

brain tumor

Focal neurological dysfunction brain tumor

+arly morning vomiting or vomiting

unrelated to headache or other illnessbrain tumor

ehavioral changes or rapid decline in

school resultsbrain tumor

/ause

Aside from e&posure to vinyl chlorideor ioni$ing radiation, there are no known

environmental factors associated with brain tumors. 6utations and deletions of so

called tumor suppressor genesare thought to be the cause of some forms of brain

tumors. 'eople with various inherited diseases, such as on !ippel1indau

syndrome, multiple endocrine neoplasia, neurofibromatosistype < are at high risk of

developing brain tumors.

Although studies have not shown any link between cell phone radiationand brain

tumors,9/scale into 8roup


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some risk of carcinogenicity, so additional research into the longterm, heavy use of

mobile phones needs to be conducted. 9;

9edit;Types

Tumors can be benignor malignant, can occur in different parts of the brain, and may or

may not be primary tumors. A primary tumor is one that has started in the brain, as

opposed to a metastatictumor, which is something that has spread to the brain from

another part of the body.9?;Tumors may or may not be symptomatic* some tumors are

discovered because the patient has symptoms, others show up incidentally on an

imaging scan, or at an autopsy.

The most common primary brain tumors are*9@;

8liomas (@.?) 6eningiomas (


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[edit]Anatomy

2rom the brainWikipedia article and for the purpose of understanding this article some

summary notes about the brain and its different types of organic tissues will be

provided.

When reading the human brain in the picture on the right, only a few of the areas are

really of interest to us. The first type of tissue encountered beneath the skullbone in the

intracranial cavity is actually not shown on this picture* the meninges. This is what is

inflamed in meningitis.

[edit]Meninges

!uman brains are surrounded by a system of connective tissuemembranes

called meningesthat separate the skullfrom the brain. This threelayered covering is

composed of (from the outside in) the dura mater(hard mother), arachnoidmater(spidery mother), and pia mater(soft mother). The arachnoid and pia are

physically connected and thus often considered as a single layer, the piaarachnoid.

Below the arachnoid is the subarachnoid spacewhich contains cerebrospinal fluid,

which circulates in the narrow spaces between cells and through cavities

called ventricles, and serves to nourish, support, and protect the brain tissue. Blood

vesselsenter the central nervous systemthrough the perivascular space above the pia

mater. The cells in the blood vessel walls are 4oined tightly, forming the blood+brain

barrier which protects the brain from to&insthat might enter through the blood. Tumors

of the meninges are meningiomaand are often benign neoplasms.

[edit]Brain matter

The brains of vertebrates(including humans) are made of very soft tissue, with a te&ture

that has been compared to gelatin. 1iving brain tissue is pinkish on the outside and

mostly white on the inside, with subtle variations in color. Three separate brain areas

make up the ma4ority of brain volume*

telencephalon (cerebral hemispheres or cerebrum)

mesencephalon (midbrain)

cerebellum

These areas are composed of two broad classes of cells* neuronsand glia. These two

types are e0ually numerous in the brain as a whole, although glial
http://en.wikipedia.org/w/index.php?title=Brain_tumor&action=edit&section=5http://en.wikipedia.org/wiki/Human_brainhttp://en.wikipedia.org/w/index.php?title=Brain_tumor&action=edit&section=6http://en.wikipedia.org/wiki/Connective_tissuehttp://en.wikipedia.org/wiki/Meningeshttp://en.wikipedia.org/wiki/Human_skullhttp://en.wikipedia.org/wiki/Human_skullhttp://en.wikipedia.org/wiki/Human_brainhttp://en.wikipedia.org/wiki/Dura_materhttp://en.wikipedia.org/wiki/Dura_materhttp://en.wikipedia.org/wiki/Arachnoid_materhttp://en.wikipedia.org/wiki/Arachnoid_materhttp://en.wikipedia.org/wiki/Pia_materhttp://en.wikipedia.org/wiki/Subarachnoid_spacehttp://en.wikipedia.org/wiki/Cerebrospinal_fluidhttp://en.wikipedia.org/wiki/Ventricular_systemhttp://en.wikipedia.org/wiki/Blood_vesselshttp://en.wikipedia.org/wiki/Blood_vesselshttp://en.wikipedia.org/wiki/Central_nervous_systemhttp://en.wikipedia.org/wiki/Toxinshttp://en.wikipedia.org/wiki/Meningiomahttp://en.wikipedia.org/wiki/Benign_neoplasmshttp://en.wikipedia.org/w/index.php?title=Brain_tumor&action=edit&section=7http://en.wikipedia.org/wiki/Vertebrateshttp://en.wikipedia.org/wiki/Telencephalonhttp://en.wikipedia.org/wiki/Cerebrumhttp://en.wikipedia.org/wiki/Mesencephalonhttp://en.wikipedia.org/wiki/Cerebellumhttp://en.wikipedia.org/wiki/Neuronshttp://en.wikipedia.org/wiki/Gliahttp://en.wikipedia.org/wiki/Glial_cellshttp://en.wikipedia.org/w/index.php?title=Brain_tumor&action=edit&section=5http://en.wikipedia.org/wiki/Human_brainhttp://en.wikipedia.org/w/index.php?title=Brain_tumor&action=edit&section=6http://en.wikipedia.org/wiki/Connective_tissuehttp://en.wikipedia.org/wiki/Meningeshttp://en.wikipedia.org/wiki/Human_skullhttp://en.wikipedia.org/wiki/Human_brainhttp://en.wikipedia.org/wiki/Dura_materhttp://en.wikipedia.org/wiki/Arachnoid_materhttp://en.wikipedia.org/wiki/Arachnoid_materhttp://en.wikipedia.org/wiki/Pia_materhttp://en.wikipedia.org/wiki/Subarachnoid_spacehttp://en.wikipedia.org/wiki/Cerebrospinal_fluidhttp://en.wikipedia.org/wiki/Ventricular_systemhttp://en.wikipedia.org/wiki/Blood_vesselshttp://en.wikipedia.org/wiki/Blood_vesselshttp://en.wikipedia.org/wiki/Central_nervous_systemhttp://en.wikipedia.org/wiki/Toxinshttp://en.wikipedia.org/wiki/Meningiomahttp://en.wikipedia.org/wiki/Benign_neoplasmshttp://en.wikipedia.org/w/index.php?title=Brain_tumor&action=edit&section=7http://en.wikipedia.org/wiki/Vertebrateshttp://en.wikipedia.org/wiki/Telencephalonhttp://en.wikipedia.org/wiki/Cerebrumhttp://en.wikipedia.org/wiki/Mesencephalonhttp://en.wikipedia.org/wiki/Cerebellumhttp://en.wikipedia.org/wiki/Neuronshttp://en.wikipedia.org/wiki/Gliahttp://en.wikipedia.org/wiki/Glial_cells


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highresolution techni0ues, such as computed tomography(/T)scans and

especially magnetic resonance imaging(6>#). Deoplasms will often show as differently

colored masses (also referred to as processes) in /T or 6># results.

Benign brain tumors often show up as hypodense (darker than brain tissue) masslesions on cranial /Tscans. =n 6>#, they appear either hypo (darker than brain tissue) or

isointense (same intensity as brain tissue) on T:weighted scans, or hyperintense (brighter

than brain tissue) on T#, although the appearance is variable.

/ontrast agent uptake, sometimes in characteristic patterns, can be demonstrated on

either /T or 6>#scans in most malignant primary and metastatic brain tumors.

'erifocal edema, or pressureareas, or where the brain tissue has been compressed by

an invasive process also appears hyperintense on T#, they might indicate the

presence a diffuse neoplasm (unclear outline)

This is because these tumors disrupt the normal functioning of theblood+brain

barrierand lead to an increase in its permeability. !owever it is not possible to diagnose

high versus low grade gliomas based on enhancement pattern alone.

8lioblastoma multiformeand anaplastic astrocytomahave been associated9by whom?;with

the genetic acute hepatic porphyrias('/T,A#',!/'and '), including positive testing

associated with drug refractory sei$ures. 9citation needed;%ne&plained complications

associated with drug treatments with these tumors should alert physicians to anundiagnosed neurological porphyria.

The definitive diagnosisof brain tumor can only be confirmed by histological

e&aminationof tumortissuesamples obtained either by means of brain biopsyor

open surgery. The histological e&amination is essential for determining the appropriate

treatment and the correct prognosis. This e&amination, performed by a pathologist,

typically has three stages* interoperative e&amination of fresh tissue, preliminary

microscopic e&amination of prepared tissues, and followup e&amination of prepared

tissues after immunohistochemical staining or genetic analysis.
http://en.wikipedia.org/wiki/Computed_tomographyhttp://en.wikipedia.org/wiki/Magnetic_resonance_imaginghttp://en.wikipedia.org/wiki/Contrast_agenthttp://en.wikipedia.org/wiki/Contrast_agenthttp://en.wikipedia.org/wiki/Blood%E2%80%93brain_barrierhttp://en.wikipedia.org/wiki/Blood%E2%80%93brain_barrierhttp://en.wikipedia.org/wiki/Blood%E2%80%93brain_barrierhttp://en.wikipedia.org/wiki/Glioblastoma_multiformehttp://en.wikipedia.org/wiki/Astrocytomahttp://en.wikipedia.org/wiki/Wikipedia:Avoid_weasel_wordshttp://en.wikipedia.org/wiki/Wikipedia:Avoid_weasel_wordshttp://en.wikipedia.org/wiki/Wikipedia:Avoid_weasel_wordshttp://en.wikipedia.org/wiki/Porphyriahttp://en.wikipedia.org/wiki/Porphyria_cutanea_tardahttp://en.wikipedia.org/wiki/Porphyria_cutanea_tardahttp://en.wikipedia.org/wiki/Acute_intermittent_porphyriahttp://en.wikipedia.org/wiki/Hereditary_coproporphyriahttp://en.wikipedia.org/wiki/Hereditary_coproporphyriahttp://en.wikipedia.org/wiki/Variegate_porphyriahttp://en.wikipedia.org/wiki/Wikipedia:Citation_neededhttp://en.wikipedia.org/wiki/Wikipedia:Citation_neededhttp://en.wikipedia.org/wiki/Medical_diagnosishttp://en.wikipedia.org/wiki/Histologyhttp://en.wikipedia.org/wiki/Histologyhttp://en.wikipedia.org/wiki/Tumorhttp://en.wikipedia.org/wiki/Tumorhttp://en.wikipedia.org/wiki/Biological_tissuehttp://en.wikipedia.org/wiki/Biopsyhttp://en.wikipedia.org/wiki/Surgeryhttp://en.wikipedia.org/wiki/Prognosishttp://en.wikipedia.org/wiki/Pathologisthttp://en.wikipedia.org/wiki/Computed_tomographyhttp://en.wikipedia.org/wiki/Magnetic_resonance_imaginghttp://en.wikipedia.org/wiki/Contrast_agenthttp://en.wikipedia.org/wiki/Blood%E2%80%93brain_barrierhttp://en.wikipedia.org/wiki/Blood%E2%80%93brain_barrierhttp://en.wikipedia.org/wiki/Glioblastoma_multiformehttp://en.wikipedia.org/wiki/Astrocytomahttp://en.wikipedia.org/wiki/Wikipedia:Avoid_weasel_wordshttp://en.wikipedia.org/wiki/Porphyriahttp://en.wikipedia.org/wiki/Porphyria_cutanea_tardahttp://en.wikipedia.org/wiki/Acute_intermittent_porphyriahttp://en.wikipedia.org/wiki/Hereditary_coproporphyriahttp://en.wikipedia.org/wiki/Variegate_porphyriahttp://en.wikipedia.org/wiki/Wikipedia:Citation_neededhttp://en.wikipedia.org/wiki/Medical_diagnosishttp://en.wikipedia.org/wiki/Histologyhttp://en.wikipedia.org/wiki/Histologyhttp://en.wikipedia.org/wiki/Tumorhttp://en.wikipedia.org/wiki/Biological_tissuehttp://en.wikipedia.org/wiki/Biopsyhttp://en.wikipedia.org/wiki/Surgeryhttp://en.wikipedia.org/wiki/Prognosishttp://en.wikipedia.org/wiki/Pathologist


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[edit]Pathology

6icrographof an oligodendroglioma, a type of brain cancer. Brain biopsy. !GF stain.

Tumors have characteristics that allow determination of its malignacy, how it will evolve

and it will allow the medical team to determine the management plan.

Anaplasia* or dedifferentiation" loss of differentiation of cells and of their orientation to

one another and blood vessels, a characteristic of anaplastic tumor tissue. Anaplastic

cells have lost total control of their normal functions and many have deteriorated cell

structures. Anaplastic cells often have abnormally high nucleartocytoplasmic ratios,

and many are multinucleated. Additionally, the nuclei of anaplastic cells are usually

unnaturally shaped or oversi$ed nuclei. /ells can become anaplastic in two ways*

neoplastic tumor cells can dedifferentiate to become anaplasias (the dedifferentiation

causes the cells to lose all of their normal structure-function), or cancer stem cells can

increase in their capacity to multiply (i.e., uncontrollable growth due to failure of

differentiation).

Atypia* is an indication of abnormality of a cell (which may be indicative for malignancy).

ignificance of the abnormality is highly dependent on conte&t.

Deoplasia* is the (uncontrolled) division of cells" as such neoplasia is not problematic

but its conse0uences are* the uncontrolled division of cells means that the mass of a

neoplasm increases in si$e, and in a confined space such as the intracranial cavity this

0uickly becomes problematic because the mass invades the space of the brain pushing

it aside, leading to compression of the brain tissue and increased intracranial pressure

and destruction of brain parenchyma. #ncreased #ntracranial pressure (#/') may be

attributable to the direct mass effect of the tumor, increased blood volume, or increased

cerebrospinal fluid (/2) volume may in turn have secondary symptoms
http://en.wikipedia.org/w/index.php?title=Brain_tumor&action=edit&section=11http://en.wikipedia.org/wiki/Micrographhttp://en.wikipedia.org/wiki/Oligodendrogliomahttp://en.wikipedia.org/wiki/Biopsyhttp://en.wikipedia.org/wiki/H%26E_stainhttp://en.wikipedia.org/wiki/Anaplasiahttp://en.wikipedia.org/wiki/Atypiahttp://en.wikipedia.org/wiki/Neoplasiahttp://en.wikipedia.org/wiki/Parenchymahttp://en.wikipedia.org/wiki/File:Oligodendroglioma1_high_mag.jpghttp://en.wikipedia.org/wiki/File:Oligodendroglioma1_high_mag.jpghttp://en.wikipedia.org/w/index.php?title=Brain_tumor&action=edit&section=11http://en.wikipedia.org/wiki/Micrographhttp://en.wikipedia.org/wiki/Oligodendrogliomahttp://en.wikipedia.org/wiki/Biopsyhttp://en.wikipedia.org/wiki/H%26E_stainhttp://en.wikipedia.org/wiki/Anaplasiahttp://en.wikipedia.org/wiki/Atypiahttp://en.wikipedia.org/wiki/Neoplasiahttp://en.wikipedia.org/wiki/Parenchyma


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Decrosis* is the (premature) death of cells, caused by e&ternal factors such as infection,

to&in or trauma. Decrotic cells send the wrong chemical signals which

prevents phagocytesfrom disposing of the dead cells, leading to a build up of dead

tissue, cell debris and to&ins at or near the site of the necrotic cells 9H;

Arterial and venous hypo&ia, or the deprivation of ade0uate o&ygen supply to certain

areas of the brain, occurs when a tumor makes use of nearby blood vessels for its

supply of blood and the neoplasm enters into competition for nutrients with the

surrounding brain tissue.

6ore generally a neoplasm may cause release of metabolic end products (e.g., free

radicals, altered electrolytes, neurotransmitters), and release and recruitment of cellular

mediators (e.g., cytokines) that disrupt normal parenchymal function.

[edit]

Classification[edit]Secondary brain tumors

econdary tumors of the brain are metastatic tumorsthat invaded the intracranial

sphere from cancersoriginating in other organs. This means that a cancerous neoplasm

has developed in another organ elsewhere in the body and that cancer cells have

leaked from that primary tumor and then entered the lymphatic systemand blood

vessels. These are most common among brain tumors. #n the %nited tates there are

about :H, new cases every year.9C;They then circulate through the bloodstream,

and are deposited in the brain. There, these cells continue growing and dividing,becoming another invasive neoplasm of the primary cancer7s tissue. econdary tumors

of the brain are very common in the terminal phases of patients with an incurable

metastasi$ed cancer" the most common types of cancers that bring about secondary

tumors of the brain are lung cancer, breast cancer, malignantmelanoma, kidney

cancerand colon cancer(in decreasing order of fre0uency).

econdary brain tumors are the most common cause of tumors in the intracranial cavity.

The skullbone structure can also be sub4ect to a neoplasm that by its very nature

reduces the volume of the intracranial cavity, and can damage the brain.

[edit]By behavior

Brain tumors or intracranial neoplasms can be cancerous(malignant) or noncancerous

(benign). !owever, the definitions of malignant or benign neoplasms differs from those

commonly used in other types of cancerous or noncancerous neoplasms in the body.

#n cancers elsewhere in the body, three malignant properties differentiate benign tumors
http://en.wikipedia.org/wiki/Necrosishttp://en.wikipedia.org/wiki/Phagocyteshttp://en.wikipedia.org/wiki/Brain_tumor#cite_note-necrs-7http://en.wikipedia.org/wiki/Hypoxia_(medical)http://en.wikipedia.org/w/index.php?title=Brain_tumor&action=edit&section=12http://en.wikipedia.org/w/index.php?title=Brain_tumor&action=edit&section=13http://en.wikipedia.org/wiki/Metastasishttp://en.wikipedia.org/wiki/Cancerhttp://en.wikipedia.org/wiki/Lymphatic_systemhttp://en.wikipedia.org/wiki/Blood_vesselshttp://en.wikipedia.org/wiki/Blood_vesselshttp://en.wikipedia.org/wiki/Brain_tumor#cite_note-8http://en.wikipedia.org/wiki/Lung_cancerhttp://en.wikipedia.org/wiki/Breast_cancerhttp://en.wikipedia.org/wiki/Melanomahttp://en.wikipedia.org/wiki/Melanomahttp://en.wikipedia.org/wiki/Kidney_cancerhttp://en.wikipedia.org/wiki/Kidney_cancerhttp://en.wikipedia.org/wiki/Colon_cancerhttp://en.wikipedia.org/wiki/Human_skullhttp://en.wikipedia.org/w/index.php?title=Brain_tumor&action=edit&section=14http://en.wikipedia.org/wiki/Canceroushttp://en.wikipedia.org/wiki/Necrosishttp://en.wikipedia.org/wiki/Phagocyteshttp://en.wikipedia.org/wiki/Brain_tumor#cite_note-necrs-7http://en.wikipedia.org/wiki/Hypoxia_(medical)http://en.wikipedia.org/w/index.php?title=Brain_tumor&action=edit&section=12http://en.wikipedia.org/w/index.php?title=Brain_tumor&action=edit&section=13http://en.wikipedia.org/wiki/Metastasishttp://en.wikipedia.org/wiki/Cancerhttp://en.wikipedia.org/wiki/Lymphatic_systemhttp://en.wikipedia.org/wiki/Blood_vesselshttp://en.wikipedia.org/wiki/Blood_vesselshttp://en.wikipedia.org/wiki/Brain_tumor#cite_note-8http://en.wikipedia.org/wiki/Lung_cancerhttp://en.wikipedia.org/wiki/Breast_cancerhttp://en.wikipedia.org/wiki/Melanomahttp://en.wikipedia.org/wiki/Kidney_cancerhttp://en.wikipedia.org/wiki/Kidney_cancerhttp://en.wikipedia.org/wiki/Colon_cancerhttp://en.wikipedia.org/wiki/Human_skullhttp://en.wikipedia.org/w/index.php?title=Brain_tumor&action=edit&section=14http://en.wikipedia.org/wiki/Cancerous


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from malignant forms of cancer* benign tumors are selflimited and do not invade or

metastasi$e. /haracteristics of malignant tumors include*

uncontrolled mitosis (growth by division beyond the normal limits)

anaplasia* the cells in the neoplasm have an obviously different form (in si$e and

shape). Anaplastic cells display markedpleomorphism. The cell nucleiare characteristically

e&tremely hyperchromatic (darkly stained) and enlarged" the nucleus might have the same

si$e as the cytoplasmof the cell (nuclearcytoplasmic ratio may approach :*:, instead of the

normal :*? or :*E ratio).8iant cells+ considerably larger than their neighbors + may form

and possess either one enormous nucleus or several nuclei (syncytia). Anaplastic nuclei are

variable and bi$arre in si$e and shape.

invasion or infiltration (medical literature uses these terms as synonymous e0uivalents.

!owever, for clarity, the articles that follow adhere to a convention that they mean slightly

different things" this convention is not followed outside these articles)*

#nvasion or invasiveness is the spatial e&pansion of the tumor through

uncontrolled mitosis, in the sense that the neoplasm invades the space occupied by

ad4acent tissue, thereby pushing the other tissue aside and eventually compressing the

tissue. =ften these tumors are associated with clearly outlined tumors in imaging.

#nfiltration is the behavior of the tumor either to grow (microscopic) tentacles that

push into the surrounding tissue (often making the outline of the tumor undefined ordiffuse) or to have tumor cells seeded into the tissue beyond the circumference of the

tumorous mass" this does not mean that an infiltrative tumor does not take up space or

does not compress the surrounding tissue as it grows, but an infiltrating neoplasm

makes it difficult to say where the tumor ends and the healthy tissue starts.

metastasis (spread to other locations in the body via lymph or blood).

=f the above malignant characteristics, some elements do not apply to primary

neoplasms of the brain*

'rimary brain tumors rarely metastasi$e to other organs" some forms of primary brain

tumors can metastasi$e but will not spread outside the intracranial cavity or the central

spinal canal. 3ue to the blood+brain barriercancerous cells of a primary neoplasm cannot

enter the bloodstream and get carried to another location in the body. (=ccasional isolated
http://en.wikipedia.org/wiki/Anaplasiahttp://en.wikipedia.org/wiki/Pleomorphism_(cytology)http://en.wikipedia.org/wiki/Cell_nucleihttp://en.wikipedia.org/wiki/Cell_nucleihttp://en.wikipedia.org/wiki/Cytoplasmhttp://en.wikipedia.org/wiki/Giant_cellshttp://en.wikipedia.org/wiki/Giant_cellshttp://en.wikipedia.org/wiki/Syncytiumhttp://en.wikipedia.org/wiki/Metastasishttp://en.wikipedia.org/wiki/Blood%E2%80%93brain_barrierhttp://en.wikipedia.org/wiki/Anaplasiahttp://en.wikipedia.org/wiki/Pleomorphism_(cytology)http://en.wikipedia.org/wiki/Cell_nucleihttp://en.wikipedia.org/wiki/Cytoplasmhttp://en.wikipedia.org/wiki/Giant_cellshttp://en.wikipedia.org/wiki/Syncytiumhttp://en.wikipedia.org/wiki/Metastasishttp://en.wikipedia.org/wiki/Blood%E2%80%93brain_barrier


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case reports suggest spread of certain brain tumors outside the central nervous system,

e.g. bone metastasis of glioblastoma multiforme.9I;)

'rimary brain tumors generally are invasive (i.e. they will e&pand spatially and intrude

into the space occupied by other brain tissue and compress those brain tissues), however

some of the more malignant primary brain tumors will infiltrate the surrounding tissue.

=f numerous grading systemsin use for the classification of tumor of the central

nervous system, the World !ealth =rgani$ation(W!=) grading systemis commonly

used for astrocytoma. Fstablished in :II in an effort to eliminate confusion regarding

diagnoses, the W!= system established a fourtiered histologic grading guideline for

astrocytomas that assigns a grade from : to ?, with : being the least aggressive and ?

being the most aggressive.

[edit]TreatmentWhen a brain tumor is diagnosed, a medical team will be formed to assess the

treatment options presented by the leading surgeon to the patient and his-her family.

8iven the location of primary solid neoplasms of the brain in most cases a donothing

option is usually not presented. Deurosurgeons take the time to observe the evolution of

the neoplasm before proposing a management plan to the patient and his-her relatives.

These various types of treatment are available depending on neoplasm type and

location and may be combined to give the best chances of survival*

surgery* complete or partial resection of the tumor with the ob4ective of removing as

many tumor cells as possible

radiotherapy* the most commonly used treatment for brain tumors" the tumor is irradiated

with beta, & rays or gamma rays.

chemotherapy* is a treatment option for cancer, however it is seldom used to treat brain

tumors as the blood and brain barrier prevents the drugs from reaching the cancerous cells.

/hemotherapy can be thought of as a poison that prevents the growth and division of all

cells in the body including cancerous cells. Thus the significant side effects associated and

e&perienced by patients undergoing chemotherapy.

A variety of e&perimental therapies are available through clinical trials9:;
http://en.wikipedia.org/wiki/Glioblastoma_multiformehttp://en.wikipedia.org/wiki/Glioblastoma_multiformehttp://en.wikipedia.org/wiki/Brain_tumor#cite_note-9http://en.wikipedia.org/wiki/Grading_of_the_tumors_of_the_central_nervous_systemhttp://en.wikipedia.org/wiki/Grading_of_the_tumors_of_the_central_nervous_systemhttp://en.wikipedia.org/wiki/World_Health_Organizationhttp://en.wikipedia.org/wiki/Grading_of_the_tumors_of_the_central_nervous_system#WHO_gradinghttp://en.wikipedia.org/w/index.php?title=Brain_tumor&action=edit&section=15http://en.wikipedia.org/wiki/Brain_tumor#cite_note-10http://en.wikipedia.org/wiki/Glioblastoma_multiformehttp://en.wikipedia.org/wiki/Brain_tumor#cite_note-9http://en.wikipedia.org/wiki/Grading_of_the_tumors_of_the_central_nervous_systemhttp://en.wikipedia.org/wiki/World_Health_Organizationhttp://en.wikipedia.org/wiki/Grading_of_the_tumors_of_the_central_nervous_system#WHO_gradinghttp://en.wikipedia.org/w/index.php?title=Brain_tumor&action=edit&section=15http://en.wikipedia.org/wiki/Brain_tumor#cite_note-10


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urvival rates in primary brain tumors depend on the type of tumor, age, functional

status of the patient, the e&tent of surgical tumor removal and other factors specific to

each case.9::;

[edit]Surgery

The primary and most desired course of action described in medical literature is surgical

removal (resection) via craniotomy. 6inimally invasive techni0ues are being studied but

are far from being common practice. The prime remediating ob4ective of surgery is to

remove as many tumor cells as possible, with complete removal being the best outcome

and cytoreduction(debulking) of the tumor otherwise. #n some cases access to the

tumor is impossible and impedes or prohibits surgery.

6any meningiomas, with the e&ception of some tumors located at the skull base, can be

successfully removed surgically. 6ostpituitary adenomascan be removed surgically,

often using a minimally invasive approach through thenasal cavityand skull base

(transnasal, transsphenoidal approach). 1arge pituitary adenomasre0uire

a craniotomy(opening of the skull) for their removal. >adiotherapy,

including stereotacticapproaches, is reserved for inoperable cases.

everal current research studies aim to improve the surgical removal of brain tumors by

labeling tumor cells with @aminolevulinic acidthat causes them to fluoresce.9:


15/32

for a total of : to treatments, depending on the type of tumor. This additional

treatment provides some patients with improved outcomes and longer survival rates.

>adiosurgery is a treatment method that uses computeri$ed calculations to focus

radiation at the site of the tumor while minimi$ing the radiation dose to the surrounding

brain. >adiosurgery may be an ad4unct to other treatments, or it may represent the

primary treatment techni0ue for some tumors.

>adiotherapy may be used following, or in some cases in place of, resection of the

tumor. 2orms of radiotherapy used for brain cancer includee&ternal beam radiation

therapy, brachytherapy, and in more difficult cases, stereotacticradiosurgery, such

as 8amma knife,/yberknifeor Dovalis T&radiosurgery.9:;

>adiotherapy is the most common treatment for secondary brain tumors. The amount of

radiotherapy depends on the si$e of the area of the brain affected by cancer./onventional e&ternal beam 7whole brain radiotherapy treatment7 (WB>T) or 7whole

brain irradiation7 may be suggested if there is a risk that other secondary tumors will

develop in the future.9:?;tereotactic radiotherapy is usually recommended in cases

involving fewer than three small secondary brain tumors.

#n ) and whole

brain radiation therapy (WB>T) for the treatment of metastatic brain tumors have more

than twice the risk of developing learning and memory problems than those treated with

> alone.9:@;9:E;

[edit]Chemotherapy

'atients undergoing chemotherapy are administered drugs designed to kill tumor cells.

Although chemotherapy may improve overall survival in patients with the most

malignant primary brain tumors, it does so in only about


16/32

how brain tumor patients are performing on current therapies. They also show a listing

of chemotherapy agents used to treat high grade glioma tumors.9:H;

[edit]!ther

A shuntis used not as a cure but to relieve symptoms by reducing hydrocephaluscaused by blockage of cerebrospinal fluid.9:C;

>esearchers are presently investigating a number of promising new treatments

including gene therapy, highly focused radiation therapy, immunotherapy and novel

chemotherapies. A variety of new treatments are being made available on an

investigational basis at centers speciali$ing in brain tumor therapies.

[edit]Prognosis

The prognosis of brain cancer varies based on the type of cancer. 6edulloblastoma hasa good prognosis with chemotherapy, radiotherapy, and surgical resectionwhile

glioblastoma multiforme has a median survival of only :< months even with

aggressivechemoradiotherapyand surgery. Brainstem gliomas have the poorest

prognosis of any form of brain cancer, with most patients dying within one year, even

with therapy that typically consists of radiation to the tumor along with corticosteroids.

!owever, one type of brainstem glioma, a focal 9:I;seems open to e&ceptional prognosis

and longterm survival has fre0uently been reported.

[edit]"lioblastoma multiforme

Main article:Glioblastoma multiforme

8lioblastoma multiforme is the deadliest and most common form of malignant brain

tumor. Fven when aggressive multimodality therapy consisting of radiotherapy,

chemotherapy, and surgical e&cision is used, median survival is only :


17/32

=ligodendroglioma is an incurable but slowly progressive malignant brain tumor. They

can be treated with surgical resection,chemotherapy, and-orradiotherapy. 2or

suspected lowgrade oligodendrogliomas in select patients, some neurooncologists opt

for a course of watchful waiting, with only symptomatic therapy. Tumors with the :p-:I0

codeletion have been found to be especially chemosensitive, and one source reports

oligodendrogliomas to be among the most chemosensitive of human solid

malignancies.9


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[edit]$nited States

#n the %nited tates in the year egistry of the %nited tates, 'rimary Brain

Tumors in the %nited tates, tatistical >eport,


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[edit]'esicular stomatitis &irus

#n


20/32

A brainstemgliomain fouryear old. 6>#sagittal,without contrast

#n the %, about


21/32

Brain tumors may originate from neural elements within the brain, or they may representspread of distant cancers. 'rimary brain tumors arise from /D tissue and account forroughly half of all cases of intracranial neoplasms. The remainder of brain neoplasmsare caused by metastatic lesions. #n adults, two thirds of primary brain tumors arise fromstructures above the tentorium (supratentorial), whereas in children, two thirds of brain

tumors arise from structures below the tentorium (infratentorial). 8liomas,metastases, meningiomas, pituitary adenomas, andacoustic neuromasaccount forI@ of all brain tumors. /lassification by tumor cell type is irrelevant to the emergencyphysician because emergent treatment is the same regardless of the tumor type.

Deoplasms, brain. /T images of several tumor types. lide courtesyof %6A /ontinuing Fducation =ffice.

6any review articles have been written on brain tumors, and this discussion at timesdraws from the consensus of these reviews. 9:,


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Deoplasms, brain. /olloid cyst of the third ventricle with obstructive

hydrocephalus. #mage courtesy of 'eter 2errera, 63.

The cumulative effects of tumor invasion, edema, and hydrocephalus may elevate theintracranial pressure (#/') and impair cerebral perfusion. #ntracranial compartmentalrise in #/' may provoke shifting or herniation of tissue under the fal& cerebri, throughthe tentorium cerebelli, or through the foramen magnum.

lowgrowing tumors, particularly tumors e&panding in the socalled silent areas of thebrain, such as the frontal lobe, may be associated with a more insidious clinical course.These tumors tend to be larger at detection.

6ost primary brain tumors do not metastasi$e, but if they do metastasi$e, intracranialspread generally precedes distant dissemination.

6etastatic brain tumors from non/D primary tumors may be the first sign ofmalignancy, or they may herald a relapse. Donetheless, the signs and symptoms ofbrain metastases simulate those of primary brain tumors.

1eptomeningeal infiltration may present with dysfunction of multiple cranial nerves.

#pidemiology

)re*uency

United States

Fstimates of the annual incidence rate of primary brain tumors range from H:I.: casesper :, population. 6etastatic tumors to the brain are more common with morethan


23/32

Mortality+Morbidity

#n the %nited tates in :III, primary cancers of the central nervous system were the

cause of death in appro&imately :,: people. Brain tumors are the second most common cancer in children, comprising :@


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interval. !eadache was the number one symptom e&perienced in more than half ofpatients.9:;

Although headache is the symptom customarily associated with an intracranial

neoplasm, it often is a late complaint. %sually, headache is not an isolated finding.o !eadache is the worst symptom in only one half of patients.

o 6ost headaches in patients with brain tumors are nonspecific and

resemble tensiontype headaches.9C, ::, :


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o Any middleaged or elderly patients presenting with a first sei$ure should

have /D tumor high in the differential diagnosis.o 'atients with a brain tumor may present with acute neurologic changes

mimicking those associated with stroke.

Physical

Do physical finding or pattern of findings unmistakably identifies a patient with a /Dneoplasm.

Based on their location, intracranial tumors may produce a focal or generali$ed

deficit, but signs may be lacking (especially if the tumor is confined to the frontal lobe)or even falsely locali$ing.

'apilledema, which is more prevalent with pediatric brain tumors, reflects an

increase in #/' of several days or longer. 'apilledema usually does not cause visualloss. Dot all patients with /D tumors develop papilledema.

3iplopia may result from displacement or compression of the si&th cranial nerve

at the base of the brain. #mpaired upward ga$e, called 'arinaud syndrome, may occur with pineal tumors. Tumors of the occipital lobe specifically may produce homonymous hemianopia

or partial visual field deficits. Deoplasms, brain. =ccipital lobeglioblastoma with surrounding edema.

Anosmia may occur with frontal lobe tumors.

Brainstem and cerebellar tumors induce cranial nerve palsies, ata&ia,

incoordination, nystagmus, pyramidal signs, and sensory deficits on one or both sidesof the body.

o Three cranial nerves run through the cerebellopontine angle* facial,

cochlear, and vestibular. 6asses in these regions may impair the functions of thesenerves.

o Acoustic neuromas most commonly originate from the vestibular nerve

(part of cranial nerve ###).Causes

Although few factors are une0uivocally associated with an increased risk of braincancer, some are conse0uential.

6ost /D neoplasms are thought to arise from individual cell mutations.
http://refimgshow%283%29/


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A prior history of irradiation to the head for reasons other than treatment of the

present tumor may increase the chance of primary brain tumor. A few inherited diseases, such as neurofibromatosis, tuberous sclerosis, multiple

endocrine neoplasia (type :), and retinoblastoma, increase the predilection to develop/D tumors.

The most common tumors originating from the cerebellopontine angle areacoustic neuroma and meningioma.

'rimary /D lymphoma is a relatively fre0uent occurrence in !# patients.

6etastatic tumors reach the brain via hematogenous dissemination through the

arterial system.o 1ung cancer is by far the most common solid tumor disseminating to the

brain, followed by breast, melanoma, and colon cancer.o 1ess common sources of metastasis are malignant melanoma,testicular

cancer, and renal cell cancer.o 'rostate, uterine, and ovarian cancersare unlikely sources of brain

metastasis.

Differential Diagnoses Fncephalitis

Fpidural !ematoma

troke, !emorrhagic

troke, #schemic

ubdural !ematoma

.aboratory Studies

'atients with cancer are predisposed to medical complications, including

bleeding disturbances (hyperviscosity), metabolic disorders (hypercalcemia), andproduction of e&cessive hormones (syndrome of inappropriate antidiuretic hormone

secretion). With clinical suspicion of cancer, obtain routine laboratory studies on admission,

including a /B/, coagulation studies, and analysis of electrolytes and comprehensivemetabolic panel.

Imaging Studies

=btain neuroimaging studies in patients with symptoms suggestive of anintracranial neoplasm (eg, acute mental status changes" newonset sei$ures" focal,motor, or sensory deficits, including gait disturbance" suspicious headache" signs ofelevated #/', such as papilledema).

Although some tumors e&hibit a characteristic appearance, do not make an

une0uivocal diagnosis based solely on radiologic findings. 8enerally, /T is the imaging modality of choice for the F3 physician.

#ntravenous contrast material assists in tumor identification. 6ost tumorsdemonstrate enhancement with contrast material administration.

Tumors may appear hypodense, isodense, or hyperdense, or they may

have mi&ed density. 6etastases to the brain tend to be multiple, but certain tumors, such as

renal cell carcinomas, tend to be solitary metastatic brain lesions.
http://emedicine.medscape.com/article/1947145-overviewhttp://emedicine.medscape.com/article/277496-overviewhttp://emedicine.medscape.com/article/279007-overviewhttp://emedicine.medscape.com/article/279007-overviewhttp://emedicine.medscape.com/article/281340-overviewhttp://emedicine.medscape.com/article/281340-overviewhttp://emedicine.medscape.com/article/458011-overviewhttp://emedicine.medscape.com/article/258148-overviewhttp://emedicine.medscape.com/article/255771-overviewhttp://emedicine.medscape.com/article/791896-overviewhttp://emedicine.medscape.com/article/824029-overviewhttp://emedicine.medscape.com/article/828005-overviewhttp://emedicine.medscape.com/article/780258-overviewhttp://emedicine.medscape.com/article/766373-overviewhttp://emedicine.medscape.com/article/246650-overviewhttp://emedicine.medscape.com/article/246650-overviewhttp://emedicine.medscape.com/article/1947145-overviewhttp://emedicine.medscape.com/article/277496-overviewhttp://emedicine.medscape.com/article/279007-overviewhttp://emedicine.medscape.com/article/279007-overviewhttp://emedicine.medscape.com/article/281340-overviewhttp://emedicine.medscape.com/article/458011-overviewhttp://emedicine.medscape.com/article/258148-overviewhttp://emedicine.medscape.com/article/255771-overviewhttp://emedicine.medscape.com/article/791896-overviewhttp://emedicine.medscape.com/article/824029-overviewhttp://emedicine.medscape.com/article/828005-overviewhttp://emedicine.medscape.com/article/780258-overviewhttp://emedicine.medscape.com/article/766373-overviewhttp://emedicine.medscape.com/article/246650-overviewhttp://emedicine.medscape.com/article/246650-overview


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With increasing availability, 6>#s may supplant /Ts as the imaging procedures

of choice. An 6># is most helpful for identifying tumors in the posterior fossa

(including acoustic neuromas), hemorrhagic lesions. #t is useful in patients with anallergy to iodinated contrast material or renal insufficiency.

3rawbacks to 6># include incompatibility with certain medical e0uipment,longer imaging times (increased risk of motion artifact), and poor visuali$ation of thesubarachnoid space.

Deither /T nor 6># can be used to differentiate tumor recurrence from

radionecrosis. =n plain skull radiographs, large pituitary adenomas are associated with a large

sella turcica.

Procedures

1umbar puncture is not indicated in the F3 in the patient with suspected /Dneoplasms.

Prehospital Care'rehospital care is supportive and directed to the presenting symptom comple&. 2ore&ample, treat sei$ures in the usual manner. Airway disturbance, breathing difficulty,signs of pronounced elevation in #/', and notable impairment of consciousness maynecessitate definitive airway control with endotracheal intubation and, possibly,hyperventilation.

#mergency Department Care

F3 treatment of the patient with an intracerebral neoplasm depends on both the natureof the tumor and the general condition of the patient. 3ecisions regarding surgicalresection, initiation of radiation treatment, and chemotherapy are beyond the scope ofpractice of the F3 physician.

/orticosteroids may dramatically reduce signs and symptoms related to cerebral

edema. Affected patients may e&perience relief within the first few hours of steroidtherapy.

o 3e&amethasone is the agent of choice because of its minimal salt

retaining properties. >ecommended doses generally range from ?


28/32

3iscuss the use of mannitol with the appropriate consultant. Although mannitol

may reduce transiently lower #/', concern about rebound increases in #/' makes itsuse problematic.

Consultations

1ocal practice patterns govern re0uests for consultations.

8enerally, care of patients with a brain tumor is multidisciplinary, re0uiring

assistance from a neurosurgeon, an oncologist, a radiologist, and an e&pert inradiation therapy.

6anagement varies greatly depending on tumor location, tissue type, and

comorbid conditions. urgical treatment options may include tumor removal or debulking, installation

of a ventricular shunt, and placement of radioactive implants.

Medication Summary

'ractice parameters from the American Academy of Deurology discourage prophylactic

use of anticonvulsants for sei$ures in patients with newly diagnosed brain tumors andsuggest that it is appropriate to taper and discontinue anticonvulsant usepostoperatively in patients without sei$ures.9:;Anticonvulsant use may be reserved forpatients with clinical sei$ures, but some physicians prescribe prophylacticanticonvulsants in patients with cortical tumors.

Corticosteroids

Class Summary

teroids are thought to stabili$e cell membranes and diminish the vasogenic edemaassociated with tumors.

iew full drug information

De,amethasone /Decadron0

%sed in treatment of vasogenic cerebral edema" improves endothelial integrity.

-yperosmolar agents

Class Summary

These agents may reduce #/' and cerebral edema by creating an osmotic gradientacross an intact bloodbrain barrier. As water diffuses from the brain into theintravascular compartment, #/' decreases.

iew full drug information

Mannitol /!smitrol0
http://reference.medscape.com/drug/decadron-dexamethasone-intensol-dexamethasone-342741http://reference.medscape.com/drug/decadron-dexamethasone-intensol-dexamethasone-342741http://reference.medscape.com/drug/osmitrol-mannitol-343061http://reference.medscape.com/drug/osmitrol-mannitol-343061http://reference.medscape.com/drug/decadron-dexamethasone-intensol-dexamethasone-342741http://reference.medscape.com/drug/decadron-dexamethasone-intensol-dexamethasone-342741http://reference.medscape.com/drug/osmitrol-mannitol-343061http://reference.medscape.com/drug/osmitrol-mannitol-343061


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6ay reduce subarachnoid space pressure by creating osmotic gradient betweencerebrospinal fluid in arachnoid space and plasma. Dot for longterm use.

)urther Inpatient Care

2urther inpatient care is comple& and may involve multiple consultants,

depending on the tumor type and overall prognosis. 3efinitive diagnosis re0uires tissue biopsy performed by a 0ualified

neurosurgeon. Additional neurosurgical options include resection or debulking and placement of

a ventricular shunt with obstructive hydrocephalus. The admitting physician should coordinate oncologic or radiation oncology

consultations.

)urther !utpatient Care

The patient7s primary physician best manages coordination of consultants, butthe responsible neurosurgeon should direct the treatment of specific postoperative

complications or care. A common problem confronting the F3 physician is a patient with a known brain

neoplasm complaining of a headache or worsening other symptoms. This scenarioalways raises the possibility of tumor recurrence or worsening cerebral edema. =btain a/T scan or 6># to rule out lifethreatening events, such as hemorrhage or herniation.

>adiation therapy for gliomas usually is performed on an outpatient basis.

Inpatient 1 !utpatient Medications

teroids or anticonvulsants may be used.

'rovide medications for patient comfort and pain control.

Transfer

Dew occurrence of /D tumor may re0uire transfer to a facility with appropriateneurosurgical staff.

peak directly to the consultant prior to transfer to address initiation of steroid or

anticonvulsant treatment.

Complications

Acute symptoms in a patient with a brain tumor, particularly when signs andsymptoms simulate the presentation of a cerebrovascular accident, suggest thepossibility of acute hemorrhage into a tumor. Brain neoplasms predisposed tohemorrhage include lung cancer, melanoma, and choriocarcinoma.

1esions near the third ventricle can cause paro&ysmal symptoms of headache,

syncope, or mental status change. Additionally, vomiting, ata&ia, memory changes,visual disturbances, or personality changes may occur.

Fpisodic increases in #/' secondary to pressure arising from blockage of

cerebrospinal fluid outflow cause transient symptoms. udden death is a reported complication from obstruction of outflow

drainage from the third ventricle.


30/32

udden increases in #/' may lead to lifethreatening brain herniation, which

shifts the brain parenchyma in the direction of least resistance* caudally through theforamen magnum (posterior fossa tumors) or transtentorial apertures.

ome pituitary tumors are hormonally active and capable of producing

acromegaly or galactorrhea. 'ituitary apople&y, an unusual complication arising from

pituitary adenomas, describes hemorrhage into the tumor, leading to headache,deterioration of vision, oculomotor palsies, and shock secondary to acute adrenalinsufficiency.

Although radiation therapy rarely causes acute to&icity with modern dosing

schedules and concomitant use of steroids, subacute or chronic effects may occur. ubacute encephalopathy occurs E:E weeks after radiation therapy and

is characteri$ed by somnolence and headaches. /hronic effects of prolonged radiation treatment tend to be more serious

and range from impairment of intellectual capacity to complete incapacity.

Prognosis

Tumor resectability, tumor location, age of the patient, and tumor histology are

the primary determinants of survival. Without radiation therapy, the mean life e&pectancy of a patient with brain

metastases is : month. >adiation therapy may e&tend survival to ?E months. 'atients with sei$ures secondary to a brain tumor generally e&perience obvious

neurologic deterioration over a Emonth course. 6ost patients with brain metastases die from progression of their primary

malignancy rather than from brain damage.

Patient #ducation

2or e&cellent patient education resources, visit e6edicine!ealth7s /ancer

/enter. Also, see e6edicine!ealth7s patient education article Brain /ancer.

Brain Cancer Staging Author* Keffrey D Bruce, 63" /hief Fditor* Kules F !arris, 63

ttp!""e(e%i*ine.(e%s*ape.*o("arti*le"2006770"p$.17!33"14 )anuari 2013

Staging of Brain Cancers

The histologic classification employed by the World !ealth =rgani$ation (W!=) forcentral nervous system (/D) tumors, shown below, makes use of ? grades. 9:,


31/32

1esions that are generally infiltrating and low in mitotic activity but recur" some tumor

types tend to progress to higher grades of malignancy 3iffuse astrocytoma, oligodendroglioma, oligoastrocytoma

Grade III:

1esions with histologic evidence of malignancy, generally in the form of mitotic activity,

clearly e&pressed infiltrative capabilities, and anaplasia Anaplastic astrocytoma, anaplastic oligoastrocytoma, anaplastic oligoastrocytoma

Grade IV:

1esions that are mitotically active, necrosisprone, and generally associated with a rapid

preoperative and postoperative evolution of disease 8lioblastoma

Brain Cancer Treatment Protocols Author* Keffrey D Bruce, 63" /hief Fditor* Kules F !arris, 63

ttp!""e(e%i*ine.(e%s*ape.*o("arti*le"2005182"p$.17!36"14anuari2013Treatment Protocols

urgical resection is the primary treatment for all tumor grades. The surgical goal isgross total resection, though less aggressive resection is employed for tumor involvingelo0uent brain.

There is significant divergence of opinion, particularly for grade ## lesions, especially forgrade ## astrocytoma. >adiation and chemotherapy dosages vary considerably amonginstitutions. Those below represent successful regimens from recent clinical trials.3e&amethasone and sei$ure treatment or prophyla&is is commonly appropriate. 9:,


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'ostoperative radiation therapy is often employed for unresectable, residual, or recurrent

tumor /hemotherapy is often used for lowgrade oligodendrogliomas, particularly with :p:I0

deletion, which is a marker for tumor susceptibility to chemotherapy9:,

Bahan Lapsus Brain Tumor

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