Term
| clinical presentation of intracranial masses |
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Definition
increased intracranial pressure (headache, vomiting, lethargy)
focal symptoms based on location
seizures
hemorrhage (from tumor) |
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Term
| manifestations of frontal mass lesions |
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Definition
behavior change
poor decision making
decreased work performance
motor weakness (if posterior) |
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Term
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Definition
| transient weakness in motor distribution of a seizure |
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Term
| manifestations of parietal mass lesions |
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Definition
contralateral motor weakness (if anterior)
contralateral sensory changes
*dominant parietal lobe syndromes*
-Gerstmann's
-receptive language errors |
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Term
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Definition
*seen in lesions of the dominant parietal lobe*
constellation of symptoms:
-agraphia without alexia
-R/L disorientation
-acalculia
-finger agnosia (inability to distinguish the fingers on the hand) |
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Term
| manifestations of temporal lobe lesions |
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Definition
language disturbances - aphasia
memory/visual impairment
seizures common |
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Term
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Definition
hydrocephalus
ataxia or gait
dysmetria of the arms
speech changes (fluency, pitch; especially in younger children) |
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Term
| different imaging modalities |
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Definition
CT, MRI, spectroscopy
(CT and MRI can be complementary) |
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Term
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Definition
PRO: fast, available, can be done without sedation in children
CON: radiation exposure, less accurate than MR (only getting density info) |
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Term
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Definition
PRO: no radiation, more accurate
CON: slower, less available, often requires sedation in children |
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Term
| use of contrast in imaging |
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Definition
contrast can leak out through BBB abnormalities to show enhancement pattern of the lesion
masses/lesions with more enhancement are often more severe |
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Term
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Definition
helps determine clinical metabolites in tissue
measure: choline/creatinine, N-acetylasparate |
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Term
| questions to ask yourself in generating a differential diagnosis to help narrow things down |
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Definition
where is the mass/lesion?
how old is the patient?
rate of onset of symptoms?
what is the imaging appearance? |
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Term
| origins of metastatic tumors |
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Definition
lung tumor are most commonly seen as metastases to the brain and are the tumor type with highest risk of going to brain
more common in adults |
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Term
| how to make a diagnostic plan |
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Definition
odds of particular diagnosis
degree of uncertainty
what is known about the natural history of the various choices (impact of delayed diagnosis)
utility of diagnosis
patient preferences |
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Term
| options for diagnostic plan |
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Definition
need to decide which to use:
serial imaging
tissue diagnosis |
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Term
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Definition
for use in the instance of low grade lesions where it is unclear whether or not resection will alter outcome
if there is evidence of stability of the mass (such as by comparing to previous imaging studies that may have been done in the past) |
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Term
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Definition
used when there might be potential danger in waiting for diagnosis
if there are treatment options with benefit
if the patient needs/want to know the prognosis
need to decide if going to perform biopsy or rescetion |
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Term
| when biopsy for diagnosis is best |
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Definition
| when mass is in deep or eloquent cortex |
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Term
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Definition
| part of brain where if damage occurs it causes immediate symptoms |
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Term
| benefits of resection over biopsy |
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Definition
may improve prognosis with tumor cell reduction
may control symptoms through reduction of mass affect
-ex: large mass adjacent to cortex but not in it
resection done when mass is in accessible, less eloquent cortex |
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Term
deep-seated tumor
biopsy or resection? |
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Definition
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Term
multiple lesions
biopsy or resection? |
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Definition
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Term
mass effect
biopsy or resection? |
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Definition
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|
Term
normal intracranial pressure
biopsy or resection? |
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Definition
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Term
clear appearance in radiologic images
biopsy or resection? |
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Definition
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|
Term
new diagnosis
biopsy or resection? |
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Definition
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Term
healthy patient
biopsy or resection? |
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Definition
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Term
diagnostic potential only (NOT therapeutic)
biopsy or resection? |
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Definition
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|
Term
no mass effect
biopsy or resection? |
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Definition
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Term
superficial tumor
biopsy or resection? |
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Definition
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Term
change in appearance
biopsy or resection? |
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Definition
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|
Term
raised intracranial pressure
biopsy or resection? |
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Definition
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Term
diagnostic AND therapeutic potential
biopsy or resection? |
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Definition
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Term
patient with systemic disease
biopsy or resection? |
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Definition
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Term
unclear appearance on radiologic images
biopsy or resection? |
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Definition
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Term
single lesion
biopsy or resection? |
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Definition
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Term
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Definition
helpful during operation to determine whether or not to proceed with total or subtotal excision; assess margin for residual tumor
tissue sample frozen and sectioned immediately in OR
provides and approximate diagnossis |
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Term
| other treatment modalities |
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Definition
corticosteroids
chemo
radiation |
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Term
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Definition
control symptoms only
palliative in high grade lesions with edema |
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Term
|
Definition
| use depends on tissue type |
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Term
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Definition
used commonly in brain tumors
dependent on tissue type
proven in many cases to improve survival |
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