TY  - CHAP
M1  - Book, Section
TI  - Tumors of the Nervous System
A1  - Kasper, Dennis L.
A1  - Fauci, Anthony S.
A1  - Hauser, Stephen L.
A1  - Longo, Dan L.
A1  - Jameson, J. Larry
A1  - Loscalzo, Joseph
Y1  - 2016
N1  - 
T2  - Harrison's Manual of Medicine, 19e
AB  - APPROACH  TO  THE  PATIENT:  Tumors  of  the  Nervous  SystemClinical  Presentation:  Brain  tumors  of  any  type  can  present  with  general  and/or  focal  symptoms  and  signs.  General  nonspecific  symptoms  include  headache  with  or  without  nausea  and  vomiting,  cognitive  difficulties,  personality  change,  and  gait  disorder.  The  classic  headache  associated  with  a  brain  tumor  is  most  evident  in  the  morning  and  improves  during  the  day,  but  this  pattern  is  actually  seen  in  only  a  minority  of  pts.  Papilledema  may  suggest  elevated  intracranial  pressure.  Focal  symptoms  and  signs  include  hemiparesis,  aphasia,  or  visual  field  deficit;  these  are  typically  subacute  and  progressive.  Seizures  are  a  common  presentation,  occurring  in  about  25%  of  pts  with  brain  metastases  or  malignant  glioma.Evaluation:  Primary  brain  tumors,  unlike  metastases,  have  no  serologic  features  of  malignancy  such  as  an  elevated  ESR  or  tumor-specific  antigens.  Cranial  MRI  with  contrast  is  the  preferred  diagnostic  test  for  any  pt  suspected  of  having  a  brain  tumor;  CT  should  be  reserved  for  pts  unable  to  undergo  MRI.  Malignant  brain  tumors  typically  enhance  with  contrast  and  may  have  central  areas  of  necrosis;  they  are  characteristically  surrounded  by  edema  of  the  neighboring  white  matter.  Low-grade  gliomas  typically  do  not  enhance.  Additional  testing  such  as  cerebral  angiogram,  EEG,  or  lumbar  puncture  is  rarely  indicated  or  helpful.  
SN  - 
PB  - McGraw-Hill Education
CY  - New York, NY
Y2  - 2024/04/19
UR  - accessmedicine.mhmedical.com/content.aspx?aid=1128788270
ER  -