Bms166 Slide Brain Tumor

7/29/2019 Bms166 Slide Brain Tumor

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BRAIN TUMORBRAIN TUMOR

YUNELDI ANWARYUNELDI ANWAR

DEPARTMENT NEUROLOGY MEDICALDEPARTMENT NEUROLOGY MEDICAL

FACULTY UNIVERSITY OF NORTHFACULTY UNIVERSITY OF NORTHSUMATERASUMATERA


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INTRODUCTIONINTRODUCTION

BRAIN TUMORBRAIN TUMOR INTRA KRANIAL, MEDINTRA KRANIAL, MEDSPINALIS AND MENINGESSPINALIS AND MENINGES

WO TYPEWO TYPE PRIMER AND SECUNDERPRIMER AND SECUNDER

PRIMER TUMORPRIMER TUMORASTROCYTE,ASTROCYTE,OLIGODENDROCYTE, EPENDEMOCYTE,OLIGODENDROCYTE, EPENDEMOCYTE,

ARACHNOID, NEUROBLAST ANDARACHNOID, NEUROBLAST AND

MEDULLUBLASTMEDULLUBLAST SEKUNDER TUMORSEKUNDER TUMOR METASTATIK FROMMETASTATIK FROM

LUNG, BREAST, COLON AND SKINLUNG, BREAST, COLON AND SKIN


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ETIOLOGYETIOLOGY

GENETICGENETIC GENE DEVIATIONGENE DEVIATION CONGENGITALCONGENGITAL TERATOMA, CHORDOMATERATOMA, CHORDOMA

,,

(< 20 yr). MENINGIOMA (> 50yr)(< 20 yr). MENINGIOMA (> 50yr)

CARSINOGENCARSINOGEN HYDROCARBON,HYDROCARBON,

NITROSAMINNITROSAMIN HEAD INYURY, INFECTION, TOKSIN,HEAD INYURY, INFECTION, TOKSIN,

RADIATION, VIRUSRADIATION, VIRUS


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Risk factors related to CNS tumorDefinitive ionizing radiation immune supression (HIV infection)

PossibleElectromagnetic field (high tension wires, cellular telepon)

Diets N-nitroso compoun s, AspartameOccupation (petroleum industry, agricultural pesticides)Household chemicals (hairdyes and sprays, household

pesticides)

Head injuryMedication (vitamin)Infections (Cysticercosis, varicella zoster, SV 40


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CONCEPT OF PATOGENESISCONCEPT OF PATOGENESISPRIMER TUMORPRIMER TUMOR

HISTOGENIC THEORYHISTOGENIC THEORY (Bayley &Cushing)(Bayley &Cushing) EMBRIOLOGICAL OF NERVE CELL AND GLIAEMBRIOLOGICAL OF NERVE CELL AND GLIA RECENT THEORYRECENT THEORY UMOR ARISES FROMUMOR ARISES FROM

TRANSFORMATION OF ASTROCYTE,TRANSFORMATION OF ASTROCYTE,OLIGODENDROCYTE, MICROGLIOCYTE,OLIGODENDROCYTE, MICROGLIOCYTE,EPENDYMOCYTEEPENDYMOCYTE NEOPLASM CELLNEOPLASM CELL MULTIPLICATION AND DIFFRENTIATIONMULTIPLICATION AND DIFFRENTIATION


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PATHOFISIOLOGYPATHOFISIOLOGY NORMAL CAVUM CRANII CONSIST OFNORMAL CAVUM CRANII CONSIST OF

Brain tissue ( 1400 gr )Brain tissue ( 1400 gr ) Cerebro spinal fluid ( 75 cc )Cerebro spinal fluid ( 75 cc )

these component any timethese component any time stabilstabil

Brain tumorBrain tumor increase intracranial pressureincrease intracranial pressure

Brain tumorBrain tumor cerebral edemacerebral edema cerebralcerebralherniationherniation


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NORMAL BRAIN


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Cerebral herniation

A. Subfacial/cingulate hern

B. Uncal herniation

C. Transtentorial/central hern

D. External herniation

E. Tonsillar herniation


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CLASSIFICATIONCLASSIFICATION HISTOPATOLOGICAL PATTERNHISTOPATOLOGICAL PATTERN

Primary brain tumorPrimary brain tumor

histologicalhistologicalbenign or malformativebenign or malformative meningiomameningiomapituitary adenoma, acustic neuroma,pituitary adenoma, acustic neuroma,

,,hemangioblastomahemangioblastomahistological malignanthistological malignant glioma (anaplasglioma (anaplastic astrocytoma, glioblastoma multiform),tic astrocytoma, glioblastoma multiform),

ependymoma, oligodendroglioma, medulloblastoependymoma, oligodendroglioma, medulloblastoma, pineal cell tumor, chroid plexus carcinomama, pineal cell tumor, chroid plexus carcinoma


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MENINGIOMA


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GLIOBLASTOMA


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CLASSIFICATIONCLASSIFICATION CONTCONT

METASTATIC BRAINMETASTATIC BRAIN TUMORSTUMORS BREASTBREAST

GI TRACTGI TRACT

PROSTATPROSTAT

SKINSKIN


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INTRA CRANIAL METASTASISINTRA CRANIAL METASTASIS

Brain parenchymaBrain parenchyma breast, lung,breast, lung,melanomamelanoma Pituitar landPituitar land breast melanomabreast melanoma

germ cellgerm cell

Dural basedDural based lung,lung, prostatprostat, breast, breast

LeptomeningealLeptomeningeal diseasedisease breast, lungbreast, lung


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SKULL METASTASISSKULL METASTASIS

Skull baseSkull base breast,breast, prostatprostat,,osteosarcomaosteosarcoma of skull, head and neckof skull, head and neckcancercancer

CalvariumCalvarium breast,breast, prostatprostat


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SPINE METASTASISSPINE METASTASIS

EpiduralEpidural lung, breast,lung, breast, prostatprostat,,neuroblastomaneuroblastoma, lymphoma. Leukemia, lymphoma. Leukemia Le tomenin ealLe tomenin eal breast lunbreast lun

IntramedullaryIntramedullary breast, colon, lung,breast, colon, lung,prostatprostat

Brachial plexusBrachial plexus lung, breast, lymphomalung, breast, lymphoma LumbosacralLumbosacral plexusplexus pelvic tumorpelvic tumor


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CLASSIFICATION BASED ONCLASSIFICATION BASED ONTOPOGRAPHY (LOCATION)TOPOGRAPHY (LOCATION)

SUPRA TENTORIAL TUMORSSUPRA TENTORIAL TUMORS Cerebral lobe and deep hemisphericCerebral lobe and deep hemispheric

, ,, ,

Sella turcica tumorSella turcica tumor pituitary tumor,pituitary tumor,

craniopharyngiomascraniopharyngiomas

INFRATENTORIAL TUMORINFRATENTORIAL TUMOR MEDULLASPINALIS TUMORMEDULLASPINALIS TUMOR


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INFRATENTORIAL TUMORSINFRATENTORIAL TUMORS ADULTSADULTS

Cerebellopontine angelCerebellopontine angel acousticacoustic

schwannomaschwannoma

, ,, ,

hemangioblastoma, ependymomahemangioblastoma, ependymoma

CHILDRENSCHILDRENS

Midline tumorsMidline tumors medulloblastomasmedulloblastomas Cerebellar lobesCerebellar lobes astrocytomasastrocytomas


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MEDULLA SPINALIS TUMORSMEDULLA SPINALIS TUMORS

EKSTRA DURALEKSTRA DURAL Metastatic tumorMetastatic tumor INTRA DURALINTRA DURAL

neurofibromasneurofibromas

Intra medullaIntra medulla ependymomaependymoma

astrositomaastrositoma


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SYMPTOMS AND SIGNSSYMPTOMS AND SIGNS

Generalized symptoms caused by raisedGeneralized symptoms caused by raisedintracranial pressureintracranial pressure

,,ischemia and compressionischemia and compression

False localizing symptoms caused by shiftsFalse localizing symptoms caused by shifts

of cerebral structuresof cerebral structures


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GENERALIZED SYMPTOMS ANDGENERALIZED SYMPTOMS ANDSIGNSSIGNS

HEADACHEHEADACHEVOMITINGVOMITING DROWSINESS VERTIGO AND DIZZINESSDROWSINESS VERTIGO AND DIZZINESS

VISUAL OBSCURATIONVISUAL OBSCURATION PERSONALITY CHANGEPERSONALITY CHANGE

CONFUSIONCONFUSION PAPILEDEMAPAPILEDEMAAPATHYAPATHY


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MECHANISM HEADACHEMECHANISM HEADACHEASSOCIATED WITH BRAIN TUMORASSOCIATED WITH BRAIN TUMOR

1.Traction on venous sinuses1.Traction on venous sinuses2.Traction on meningeal arteries2.Traction on meningeal arteries

..

brainbrain

4.Pressure on cranial and cervical pain sensi4.Pressure on cranial and cervical pain sensi

tive structuretive structure5.Dilatation of intracranial arteries5.Dilatation of intracranial arteries

6.Inflamation of pain6.Inflamation of pain--sensitive structuressensitive structures


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FOCAL SYMPTOMS AND SIGNSFOCAL SYMPTOMS AND SIGNS

FRONTAL LOBEFRONTAL LOBE Generalized seizureGeneralized seizure

Expressive aphasia (dominant size)Expressive aphasia (dominant size)

Behavioral changesBehavioral changes

DementiaDementia Gait disorders, incotinenceGait disorders, incotinence

HemipareseHemiparese


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Frontal lobe tumor


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FOCAL SYMPTOMS & SIGNSFOCAL SYMPTOMS & SIGNS

BASAL GANGLIABASAL GANGLIA Hemiparesis (contralateral)Hemiparesis (contralateral)

PARIETAL LOBEPARIETAL LOBE Receptive aphasia (dominant size)Receptive aphasia (dominant size)

Spatial disorientation (non dominant)Spatial disorientation (non dominant) Cortical sensory dysfungtion (contralat)Cortical sensory dysfungtion (contralat)

AgnosiasAgnosias


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Metastase parietal lobe tumor


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OCCIPITAL LOBEOCCIPITAL LOBE Hemiparesis (contralateral)Hemiparesis (contralateral)Visual disturbanceVisual disturbance

Complex partial (psychomotor) seizuresComplex partial (psychomotor) seizures Generalized seizuresGeneralized seizures Behavioral changesBehavioral changes

Olfactory and complex seizuresOlfactory and complex seizuresVisual aurasVisual aurasVisual field defectVisual field defect


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Occipital lobe tumor


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Temporal lobe tumor


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CORPUS COLLOSUMCORPUS COLLOSUM Dementia (anterior)Dementia (anterior)

Behavioral changesBehavioral changes

emory oss pos er oremory oss pos er orAsymptomatic (mid)Asymptomatic (mid)

THALAMUSTHALAMUS

Sensory loss (contralateral)Sensory loss (contralateral) Behavioral changes (posterior)Behavioral changes (posterior)

Languange disorders (dominant size)Languange disorders (dominant size)


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MIDBRAINS/PINEALMIDBRAINS/PINEAL Paresis of vertical eyemovementParesis of vertical eyemovement Pupillary abnormalitiesPupillary abnormalities

SELLA/OPTIC NERVE/PITUITARYSELLA/OPTIC NERVE/PITUITARY EndocrinopathyEndocrinopathy Bitemporal hemianopiaBitemporal hemianopia

Monocular visual defectMonocular visual defect Opthalmoplegia (cavernous sinus)Opthalmoplegia (cavernous sinus)


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Pineal tumor


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Pituitary tumor


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FOCAL SYMPYOMS & SIGNSFOCAL SYMPYOMS & SIGNS PONS/MEDULLAPONS/MEDULLA

Cranial nerve dysfungtionCranial nerve dysfungtionAtaxia, nystagmus, spasticityAtaxia, nystagmus, spasticity

Weakness, sensory lossWeakness, sensory loss

CERBELLO PONTINE ANGLECERBELLO PONTINE ANGLE Deafness (ipsilateral)Deafness (ipsilateral)

Loss of facial sensation (ipsilateral)Loss of facial sensation (ipsilateral)

Facial weakness (ipsilateral), ataxiaFacial weakness (ipsilateral), ataxia CEREBELLUMCEREBELLUMAtaxia (ipsilateral)Ataxia (ipsilateral)

NystagmusNystagmus


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Cerebellum tumor


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FALSE LOCALIZING SIGNSFALSE LOCALIZING SIGNS

CRANIAL NERVECRANIAL NERVEAnosmiaAnosmia

, ,, ,

Face pain, numbness, and weaknessFace pain, numbness, and weakness

Tnnitus, hearing lossTnnitus, hearing loss


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FALSE LOCALIZING SIGNSFALSE LOCALIZING SIGNS

PARENCHYMAL SIGNSPARENCHYMAL SIGNS IpsilateralIpsilateral hemiparesishemiparesis

Visual field defect, cortical blindnessVisual field defect, cortical blindness

AtaxiaAtaxia

OTHER SIGNSOTHER SIGNS NuchalNuchal rigidityrigidity


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SYMPTOM AND SIGN SPINALSYMPTOM AND SIGN SPINALCORD TUMORCORD TUMOR

INTRAMEDULLARYINTRAMEDULLARY Sensory lossSensory loss

Pain +Pain +

Decreased rectal toneDecreased rectal tone

spasticityspasticity upper motor neuron signsupper motor neuron signs

Common tumorCommon tumor -->> EpendymomaEpendymoma,, astrositomaastrositoma


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Symptom and signs spinal cordSymptom and signs spinal cordtumortumor

IntraduralIntradural andand extramedullaryextramedullary Pain,Pain, metastasemetastase ++++++

,,

RadicularRadicular or local sensory lossor local sensory loss

RadicularRadicular or segmental weakness andor segmental weakness and

sensory losssensory loss Upper motor neuron signsUpper motor neuron signs

Common tumorsCommon tumors

MeningiomaMeningioma


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Symptom and sign spinal cordSymptom and sign spinal cordtumortumor

EPIDURALEPIDURAL Pain +++Pain +++

Common tumorsCommon tumors MetastasisMetastasis


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DIAGNOSIS BRAIN TUMORDIAGNOSIS BRAIN TUMOR

HISTORYHISTORY GENERAL PHYSICAL EXAMINATIONGENERAL PHYSICAL EXAMINATION

LABORATORY FINDING, ESPECIALLYLABORATORY FINDING, ESPECIALLYIMAGINGIMAGING


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Laboratory findingsLaboratory findings

IMAGINGIMAGING CT ScanCT Scan

Magnetic resonance spectroscopy (MRS)Magnetic resonance spectroscopy (MRS)

Fungtional MRIFungtional MRI

BIOPSYBIOPSY Defenitive diagnosisDefenitive diagnosis


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DIFFRENTIAL DIAGNOSIS OFDIFFRENTIAL DIAGNOSIS OFBRAIN TUMORSBRAIN TUMORS

HEMATOMAHEMATOMAABCESSABCESS

PARASITIC INFECTIONPARASITIC INFECTION CYSTYCIRCOSISCYSTYCIRCOSISVASCULAR MALFORMATIONVASCULAR MALFORMATION

MULTIPLE SCLEROSISMULTIPLE SCLEROSIS CEREBRAL INFARCSCEREBRAL INFARCS


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Therapy of Intra Cranial TumorsTherapy of Intra Cranial Tumors

Definitive therapyDefinitive therapy SurgerySurgery Biopsi, resectionBiopsi, resection

Streotactic radiosurgeryStreotactic radiosurgery Heavy particlesHeavy particles

BrachytherapyBrachytherapy

ChemotherapyChemotherapy Parentral, lokalParentral, lokal Experimental modalitiesExperimental modalities

Supportive therapySupportive therapy


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Experimental modalitiesExperimental modalities

Angiogenesis inhibitorAngiogenesis inhibitor Growth factor inhibitorGrowth factor inhibitor

ImmunotherapyImmunotherapy Gene therapyGene therapy

Antisense oligonucleotideAntisense oligonucleotide


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Supportive TherapySupportive Therapy

AnticonvulsantAnticonvulsant CorticosteroidsCorticosteroids--

Psychotropic agentsPsychotropic agents Physical therapyPhysical therapy


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Goals of SurgeryGoals of Surgery

Establish the diagnosisEstablish the diagnosis Cure the patientCure the patient

Relieve symptomsRelieve symptoms Improve neurologic fungtionImprove neurologic fungtion

Extend duration and quality of liveExtend duration and quality of live


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Basic concepts in cancerBasic concepts in cancerchemotherapychemotherapy

Chemotherapeutic agent kill only aChemotherapeutic agent kill only apercentage of cancer cellpercentage of cancer cell Some dru s kill onl dividin cellsSome dru s kill onl dividin cells

Multiple drugs with differing site of actionMultiple drugs with differing site of actionare better than a single drugsare better than a single drugs

High dosee are better than low dosesHigh dosee are better than low doses


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Brain tumors anticonvulsantBrain tumors anticonvulsant

ProphylaxisProphylaxis---- does not prevent first seizuredoes not prevent first seizure

---- robabl useful in erio erative eriodrobabl useful in erio erative eriod

TreatmentTreatment---- efficacy unclearefficacy unclear

---- side effects more commonsside effects more commons

---- hard to control levelshard to control levels

---- best drug unknownbest drug unknown


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Advantages and DisadvantagesAdvantages and Disadvantagesof corticosteroidof corticosteroid

AdvantagesAdvantages---- control neurologic symptom by reducecontrol neurologic symptom by reduce

edemaedema

---- decrease acute RT toxicitydecrease acute RT toxicity---- relieve emesis from chemotherapyrelieve emesis from chemotherapy

---- oncolytic (lymphoma)oncolytic (lymphoma)

DisadvantagesDisadvantages---- side effects commonside effects common

---- decrease chemotherapy entrydecrease chemotherapy entry

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Bms166 Slide Brain Tumor

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