PRIMARY CNS TUMORS
A-elements normally present in CNS1-Neural tube derivatives
a-glial cells
1-astrocytes astrocytoma 1-4
2-oligodendrocytes oligodendroglioma
3-ependymocytes
a-ependymoma
b-choroid plexus papilloma
c- choroid plexus carcinoma
d-colloid cysts
b-neurons
-medulloblastomas
-ganglioneuromas
-gangliogliomas
c-pinealocytes
-pineocytomas
-pineoblastomas
2-Neural crest derivatives
a-schwann cells
-schwanomas : acoustic neuromas
-neurofibromas
b-arachnoid cap cells : meningiomas
c-melanocytes : melanomas
3-Other cells
a-connective tissue :primary cerebral sarcomasb-REC: primary CNS lymphoma
c-vascular cells: haemangioblastomas
d-glomus jugulare cells: glomus jugulare tumors
e-adenohypophyseal cells: pituitary adenomas
B-embryonal remnants
1-ectodermal derivativesa-craniopharyngiomas
b-dermoid & epidermoid cysts
2-notochord : chordomas
3-adipose cells: lipomas
4-germ cells : germinomas
5-all 3 germ layers : teratomas
Cinical presentation
-progressive neurological deficit 68%-usually motor weakness 45%
-headache 54%
-seizures 26%
Supratentorial tumors
1-due to increased icpa-from mass effect of tumor & or/ edema
b-blockage of csf less common
2-focal deficits
a-destruction of brain parenchyma by tumor invasion
b-compression of brain parenchyma by mass & / or peritumoral edema & / or haemorrhage
c-compression of cranial nerve(s)
3-headache
4-seizures
5-mental status changes-depression-lethargy-apathy-confusion
6-symptoms suggestive of TIA or stroke
a-occlusion of a vessel by tumor cells
b-haemorrhage into the tumor
7-pituitary tumors
a-endocrine disturbances
b-pituitary apoplexy
c-CSF leak
infratentorial tumors
1-s & s of increased ICP due to hydrocephalus
a-headache
b-nausea & vomiting
c-papilledema
d-gait disturbance/ ataxia
e-vertigo
f-diplopia
2-s/s indicative of mass effect in various locations within the post fossa
a-lesions in the cerebellar hemisphere may cause ataxia of the extremities, dysmetria, intention tremor
b-lesions of cerebellar vermis may cause broad based gait, trunkal ataxia
c-brain stem involvement usually results in multiple cranial nerve & long tract abnormalities
headache with brain tumors
-may occur with or without elevated ICP-equally present with primary or metastatic tumors
-worse in the morning
-exacerbated by coughing, straining, or bending forward
-associated with nausea & vomiting
-temporarily relieved by vomiting
Etiology
-the brain itself is not pain sensitive
1-increased ICP
a-tumor mass effect
b-hydrocephallus
c-mass effect from associated edema
d- mass effect from associated haemorrhage
2-invasion or compression of pain sensitive structures
a-dura
b-blood vessels
c-periosteum
3-secondary to difficulty with vision
4-extreme hypertension resulting from increased ICP (part of Cushings triad)
5-psychogenic