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brain tumors (presentation (neurological signs correlate to tumor…

- - - - Worse in the morning; wakes them up
        h with coughing / leaning forward (30%)
        May be associated and i with vomiting
  - - - thoughts, reasoning, behaviour, memory loss
    - - behaviour, memory, emotion, hearing + vision pathways
    - - blanace and co-ordination
    - - vision
    - - intellect, thought, reasoning, memory
- - - - 2-15yrs survival
      - pilocytic, pleomorphic, xanthoastrocytoma, subependymal giant cell
      - treatment of choice= surgery =curative
        
        radiotherapy: only if recurrence/ progression not amenable to surgery
      - Truly benign
        Slow growing
        Children, young adults
        Pilocytic astrocytomas
        : optic nerve, hypothalamic gliomas
        -cerebellum, brainstem
    - - GRADE 4
        
        Glioblastoma Multiforme
        
        most common primary tumour
        
        median survival 12-14 months,
        
        spreads via white matter tracking/ CSF pathways
      - Treatment
        
        non curative surgery to ^ QOL
        
        cytoreduction- reduce the mass effect
        
        supramarginal resection if non-eloquent
        
        post-op radiotherapy: external beam radiation
        
        s/fx- drops IQ by 10. kin, hair, tired
        
        Stupp protocol (NEJM 2005) = Sx + RT + TMZ improves median survival to 14 months
        
        MGMT gene- good for chemo drug thherapy target.
        
        If mgmt methylated some of the pts can survive 4yrs or so (unreliable)
        
        Chemo
        mozolomide
        PCV (Procarbazine, CCNU, vincristine)
        
        Carmustine wafers
      - GRADE 3
        
        anaplastic astrocytoma- can arise de novo or progress from grade 2.
        
        median survival 2 yrs.
    - - temporal lobe, posterior frontal, anterior parietal
        
        wont enhance on contrast
      - Treatment
        
        +/-serial imaging, radiation, chemotherapy, combined radiation/ chemotherapy
        
        depending on molecular profile (IDH-1, 1p19q co-deletion – better prognosticators of survival
        
        Radiotherapy if incomplete removal/ malignant degeneration
        
        surgery
        
        biopsy, seizure control, herniation, CSF obstruction, cytoreduction of tumor
      - presentation=seizures
      - poor prognostic factors
        
        age >50, focal defecit e.g. seizures, short duration of seizures, ^ICP, altered consciousness, enhancement on contreast studies
      - Fibrillary, gemistocytic, protoplasmic
        Hypercellularity, Pleomorphism, Vascular proliferation, Necrosis
      - ultimately benign all will become grade 3/4 over time
  - - - smaller peak in children age 6-12.
    - - calcifications (usually peripheral) cysts, peritumoral haemorrhages.
      - colllisions tumors
        
        oligodendroglial cells coexist with astrocytic cells in a neoplastic collision type of tumour. Possibly originate from the common precursor to oligodendrocytes and astrocytes: O2A cells.
    - - malignant conversion
    - - Chemosensitive
        
        Procarbazine, Lomustine, Vincristine
        
        Surgery + Chemotherapy
        
        Surgery for high grade less convincing
        
        radiotherapy controversial but decreases seizures
- - - - present in germinom and choriocarcinoma and syncytiotrophoblasts.