Internal Medicine

0521779407-20 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:22

Tumors, Intracranial 1471

■False localizing signs – eg, 3rd or 6th nerve palsy or extensor plantar

responses from herniation syndromes

■Focal deficits depending on tumor location

➣Frontal: focal & generalized seizures, intellectual changes, pyra-

midal weakness, aphasia

➣Temporal: complex partial seizures, personality change, memory

disturbance, visual field defects, aphasia

➣Parietal: simple partial seizures (sensory or motor), sensory dis-

turbances, sensory neglect, apraxia, visual field defects

➣Occipital: Field defects, visual hallucinations, seizures

➣Brain stem or cerebellar: diplopia, dysarthria, dysphagia, weak-

ness or sensory disturbance (or both) in face or limbs, vertigo,

ataxia

tests

■Cranial CT scan or MRI w/ contrast enhancement will detect, define

& localize lesion

■If cerebral metastases are likely, screen for primary lesion

■Lab studies generally unhelpful; CSF studies of limited help; lumbar

puncture may provoke herniation syndrome

differential diagnosis

■Other structural lesions are distinguished by imaging findings

■May be family history of neurofibroma, retinoblastoma, heman-

gioblastoma

■Medulloblastoma, brain stem glioma, craniopharyngioma, cerebel-

lar astrocytoma occur most commonly in childhood

■Primary cerebral lymphoma is assoc w/ AIDS

management

■Steroids reduce cerebral edema

■Herniation syndrome treated with dexamethasone; mannitol also

effective short term

■Anticonvulsants if seizures occur

specific therapy

■Treatment depends on tumor type, site & size

■Surgery permits histologic diagnosis; extra-axial tumors can often

be removed; some other tumors can also be removed or debulked,

w/ reduction in ICP; shunting procedures relieve obstructive hydro-

cephalus

■Irradiation or chemotherapy is indicated for certain tumor types