Internal Medicine

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

1472 Tumors, Intracranial Tumors, Spinal

follow-up

■Depends on type of tumor & whether complete surgical resection is

possible

complications and prognosis

Complications

■Incidence depends on tumor type & location

■Cerebral edema: treat as above

■Herniation syndrome: treat as above

■Obstructive hydrocephalus: treat as above

■Seizures: anticonvulsants

■Tumor spread: irradiation or chemotherapy if feasible

Prognosis

■Depends on tumor type; extra-axial primary lesions often resectable

completely (eg, acoustic neuroma, meningioma) w/ good prognosis;

glioblastoma multiforme & brain stem gliomas have poor prognosis–

usually inoperable or total removal not possible; oligodendroglioma

& cerebellar hemangioblastoma have good prognosis if removed

completely; metastases often multiple & not resectable–prognosis

is of primary neoplasm

TUMORS, SPINAL

MICHAEL J. AMINOFF, MD, DSc

history & physical

■Pain in back or limbs in radicular or diffuse distribution; worse on

coughing or straining

■Weakness, numbness or paresthesias below level of lesion

■Bladder, bowel, sexual dysfunction

■Progression may be gradual, but acute deterioration may occur

unpredictably

■Spinal tenderness sometimes present

■Lower motor neuron deficit may be evident at level of lesion: upper

motor neuron deficit (spastic paraparesis) below lesion

■Sensory disturbance below level of lesion

■Brown-Sequard syndrome sometimes present (ipsilateral pyramidal

deficit, hyperesthesia, impaired vibration and postural sense; con-

tralateral analgesia)