Brain Tumors

Abstract

This chapter begins with a discussion of common major clinical features and mechanisms of damage produced by brain tumors. Brain tumors are a collection of neoplasms of differing cell types, biology, prognosis, and treatment arising as a primary tumor or metastasis. Primary brain tumors in adults develop mainly above the tentorium while primary tumors develop in infants and children mainly in the posterior fossa. Most CNS tumors are of glial origin. Brain tumors produce signs and symptoms by three mechanisms: tumor location, tumor mass producing signs, and symptoms as it expands in a closed intracranial space, and finally the mass creating sufficient increased intracranial pressure to shift intracranial structures resulting in downward brain herniation. Brain tumors often cause cerebral edema with excess fluid either locally or diffusely in the brain. The cerebral edema can be vasogenic, cytotoxic, or interstitial. The chapter then discusses malignant glioma, meningioma, pituitary adenoma, and cerebral metastasis with attention to their pathophysiology, major clinical features, major laboratory findings, and principles of management and prognosis.

A 70-year-old man developed a new right-sided headache that slowly became more intense over 2 weeks. He then noted weakness in his left arm that progressed over 1 week. An MRI scan ordered by his physician demonstrated a 4 cm irregular mass in the right frontal lobe that had a heterogeneous low intensity center surrounded by an irregular ring of gadolinium enhancement and adjacent cerebral edema. A right craniotomy with moderate debulking of the mass that was a malignant glioma. He received whole head irradiation with lessening of the headache. Over the next 5 months the headache returned in spite of receiving dexamethasone and the weakness progressed to a left hemiplegia and hemisensory loss. He died 6 months after the diagnosis.