Inherited syndromes with an increased risk of brain tumours include neurofibromatosis, von Hippel-Lindau disease, tuberous sclerosis and Li-Fraumeni syndrome
Ionising radiation
Immunosuppression
Pathophysiology
Aetiology of tumour headache
Raised ICP
Invasion/compression of dura, BVs, periosteum
Secondary to diplopia (CN III, IV, VI; INO)
Secondary to difficulty focusing
Extreme hypertension
Psychogenic (stress of loss of functional capacity)
Neurological signs correlate to tumour location
Histological types
High-grade:
Gliomas and glioblastoma multiforme
Primary cerebral lymphomas
Medulloblastomas
Low-grade:
Meningiomas
Acoustic neuromas
Pituiary tumours
Pineal tumours
Craniopharyngiomas
Neurofibromas
Clinical presentation
Progressive neurological deficit
Usually motor weakness
Headache
May occur with or without raised ICP
Worse in the morning - wakes them up
Worse with coughing and leaning forward
May be associated with and made worse by vomiting
OR symptoms similar to tension HA/migrane
Seizures
Investigations
Diagnosis largely rests on brain imaging - e.g. CT scan and/or MRI scan (MRI more sensitive)
Other imaging may be used e.g. technetium brain scan is useful in the diagnosis of destructive skull vault (eg, metastases) and skull base lesions
Lesion biopsy
Management
Surgery
Tumours should be resected whenever possible (may not always be a viable option)
Surgery will also provide tissue for a formal diagnosis
Radiotherapy
External beam radiotherapy can be curative for many patients and also prolongs survival
Whole brain radiation is used with some tumours
Chemotherapy
The role of chemotherapy in brain tumours is not as marked as in other tumours - does provide modest benefit and is important in palliative care and as an adjunct to combined surgery and radiotherapy
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