Intracranial tumors

By Prof. Dr. Ayman Youssef Ezeddin Eassa

 Brain is the commonest seat for new growth. Modern diagnostic techniques are available, with efficient and earlier diagnosis. 4% fatal outcome.

Definition
Means occupying the intracranial cavity 1. Neoplastic masses 2. Chronic infective 3. Brain abscess

Neoplastic
1. Primary
1. 2. 3. 4. Gliomas (glial cells) Sheaths meningioma, neuroma Pituitary tumor, craniopharyngioma(midline) Blood vessels angioblastoma (AVM)

2. Metastasis 3. Primary CNS lymphomas

Neoplastic (cont.)
Characteristics: 1. No metastasis 2. No neurons 3. Closed rigid skull size

Neoplastic (cont.)
Infratentorial gliomas are below the age of 20 years. Meduloblastoma children. Glioblastoma supratentorial, middle life, infiltrative, highly vascular with hemorrhages and areas of necrosis.

Neoplastic (cont.)
Relatively benign
Astrocytoma adults supratentorial child infratentorial common in cerebellum with cystic cavity. Oligodendroglioma in cerebral hemisphere with calcification Ependymoma ventricle lining in children.

Neoplastic (cont.)
Meningioma from arachnoid sheath, from arachnoid villi, along venous sinuses firm, poorly supplied by blood. associated with hyperostosis. doesnt invade the brain, but invades the bone. Angioma, angioblastoma

Neoplastic (cont.)
Secondary Lung, breast, melanoma, testicular carcinoma, thyroid, kidney, rarely sarcoma. Usually multiple melanoma

Neoplastic (cont.)
Secondary (cont.) Clinically : Onset : slow- rapid C/O: headache, vomiting, blurring of vision, epilepsy, weakness, numbness.

Neoplastic (cont.)
General manifestations: Due to increased ICP mechanism: 1. Mass 2. Venous edema 3. Ventricular arachnoid villi

Neoplastic (cont.)
General manifestations: Due to increased ICP (cont.) if the tumor is in a silent area general 1st 1. Headache
1. 2. Stretch Distension

2. 3. 4. 5. 6. 7.

Vomiting Papilledema Mental changes Hypopituitarism Pulse, BP, respiration reflexes

Neoplastic (cont.)
General manifestations: Due to increased ICP (cont.) false localisation 1. Cranial nerves 6, 3 (stretch, compression by BVs) 2. Hypopituitarism 3. Pyramidal manifestations 4. cerebellar

Neoplastic (cont.)
Focal manifestations: 1. Irritative 2. Destructive Frontal: 1. Speech 2. Eye field 3. Mental 4. Graspfits 5. Motor 6. Anosmia 7. Optic atrophy 8. jacksonian

Neoplastic (cont.)
Focal manifestations: (cont.) Parietal: 1. Sensory: loss of cortical sensation 2. Lower quadrantic hemianopia . 3. Receptive dysphasia (spoken, written) 4. Topoagnosia 5. Anosagnosia 6. Silent 7. Hypotonia + waisting

Neoplastic (cont.)
Focal manifestations: (cont.) Temporal lobe 1. Fits 2. Hallucinations (smell, hearing, gustatory) 3. Receptive aphasia (spoken) 4. Illusions 5. Stereotypy 6. Upper quadrantanopia

Neoplastic (cont.)
Focal manifestations: (cont.) Occipital 1. Visual hallucinations 2. Fits 3. hemianopia

Neoplastic (cont.)
Focal manifestations: (cont.) Brain stem 1. Consciousness 2. Cranial nerves 3. Vertigo 4. Myoclonus 5. Crossed hemiplegia/ quadreplegia 6. Cerebellar 7. Sensory Midbrain 1. Tonic fits 2. Suspended consciousness

Neoplastic (cont.)
Investigations 1. Head Xray, chest Xray 2. EEG 3. Angiography 4. Ventriculography 5. CAT 6. MRI 7. Brain scan 8. PET