Kaohsiung Armed Forces General Hospital

INTRODUCTION
Brain tumors are a diverse group of neoplasms arising from different cells within the central nervous system (CNS) or from systemic cancers that have metastasized to the CNS. Systemic cancers most likely to metastasize to the CNS include lung cancer, melanoma, and breast cancer.

CLINICAL FEATURES

• Headache — Headache is a common manifestation of brain tumors and a presenting symptom in up to half of patients.
• Seizures — Focal seizures are among the most common symptoms of primary and metastatic brain tumors.
• Focal deficits — Focal signs and symptoms of brain tumors vary based on tumor location. Symptoms may be caused by local tissue disruption, mass effect on nearby structures, or vasogenic edema.
• Cognitive dysfunction — Cognitive dysfunction, which includes memory problems and mood or personality change, is common among patients with primary and metastatic brain tumors.
• Increased intracranial pressure — Increased ICP can arise either from a large mass or from restriction of cerebrospinal fluid (CSF) outflow causing hydrocephalus. Symptoms may be subtle or consist of the classic triad \ of headache, nausea, and papilledema.

NEUROIMAGING FEATURES
Magnetic resonance imaging (MRI) with contrast is the optimal study for resolution of brain tumors. Computed tomography (CT) has much lower resolution and is relied upon primarily in emergency settings, for a more detailed view of bony structures, and in patients with a contraindication to MRI.

• High-grade glioma — High-grade gliomas are typically hypointense masses on T1-weighted images that enhance heterogeneously following contrast infusion.
• Low-grade glioma — Low-grade gliomas in adults generally appear as T2/FLAIR hyperintense, expansile lesions involving both cortex and underlying white matter
• Primary CNS lymphoma — Primary central nervous system lymphoma (PCNSL) is a rare form of non-Hodgkin lymphoma that occurs in both immunocompetent and immunocompromised adults.
• Brain metastases — Brain metastases typically appear as rounded, well-circumscribed masses that enhance after administration of contrast
• Meningioma — On MRI, a typical meningioma is an extra-axial, dural-based mass that is isointense or hypointense to gray matter on T1 and isointense or hyperintense on T2-weighted images.

TREATMENT

• Role of glucocorticoids — High-dose glucocorticoids effectively reduce cerebral edema and can improve headaches and neurologic deficits caused by peritumoral edema.
• Antiseizure drugs — Patients presenting with a seizure and those who provide a clinical history suggestive of seizure activity should be treated with an antiseizure drug.
• Urgency of neurosurgical evaluation — The urgency of neurosurgical evaluation for a newly discovered brain tumor depends on the clinical stability of the patient, symptom severity, and tumor size and location.