RT Book, Section
A1 Jameson, J. Larry
A1 Fauci, Anthony S.
A1 Kasper, Dennis L.
A1 Hauser, Stephen L.
A1 Longo, Dan L.
A1 Loscalzo, Joseph
SR Print(0)
ID 1167064396
T1 Tumors of the Nervous System
T2 Harrison's Manual of Medicine, 20e
YR 2020
FD 2020
PB McGraw-Hill Education
PP New York, NY
SN 9781260455342
LK accessmedicine.mhmedical.com/content.aspx?aid=1167064396
RD 2024/04/23
AB APPROACH  TO  THE  PATIENTTumors  of  the  Nervous  SystemClinical  PresentationBrain  tumors  can  present  with  general  and/or  focal  symptoms  and  signs.  Nonspecific  symptoms  include  headache  with  or  without  nausea  and  vomiting,  cognitive  difficulties,  personality  change,  and  gait  disorder.  The  classic  brain  tumor  headache  predominates  in  the  morning  and  improves  during  the  day,  but  this  pattern  is  seen  only  in  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  common,  occurring  in  ∼25%  of  pts  with  brain  metastases  or  malignant  glioma,  and  are  the  presenting  symptom  in  up  to  90%  of  pts  with  low-grade  glioma.EvaluationPrimary  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.  Meningiomas  have  a  typical  appearance  on  MRI  because  they  are  dural-based  enhancing  tumors  with  a  dural  tail  that  compress  but  do  not  invade  the  brain.  Additional  testing  such  as  cerebral  angiogram,  EEG,  or  lumbar  puncture  is  rarely  indicated  or  helpful.