Академический Документы
Профессиональный Документы
Культура Документы
Anatomy of brain
The brain is the center of thoughts, emotions, memory and speech. Brain also control muscle movements and interpretation of sensory information (sight, sound, touch, taste, pain etc)
MRI of brain
Compartments of brain
Supratentorial compartment
Cerebral hemisphe res Basal ganglia Thalamic nuclei Lateral ventricles Hypothal amus Corpus callosum
Infratentorial compartment
Cerebel lum Brain stem (MB/P/ MO) 4th ventricle
They are created by an abnormal and uncontrolled cell division, normally either in the brain itself neurons glial cells (astrocytes, oligodendrocytes, ependymal cells, myelin-producing Schwann cells), lymphatic tissue, blood vessels
in the cranial nerves, in the brain envelopes (meninges), skull, pituitary and pineal gland, or spread from cancers primarily located in other organs (metastatic tumors).
b.Oligodendroglial tumors.
Oligodendroglioma . Anaplastic oligodendroglioma .
c.Mixed gliomas.
Oligoastrocytoma. Anaplastic oligoastrocytoma.
d.Ependymal tumors.
Myxopapillary ependymoma. Subependymoma. Ependymoma (including cellular, papillary, clear cell, and tanycytic). Anaplastic ependymoma.
II.Neuronal and mixed neuronalglial tumors (some glial component may be present).
Gangliocytoma. Ganglioglioma. Desmoplastic infantile astrocytoma/gangliogli oma. Dysembryoplastic neuroepithelial tumor. Central neurocytoma. Cerebellar liponeurocytoma. Paraganglioma.
III.Nonglial tumors.
a.Embryonal tumors.
Ependymoblastoma. Medulloblastoma. Supratentorial primitive neuroectodermal tumor (PNET).
2.MENINGEAL TUMORS.
Meningioma.(be
nign,atypical&mali gnant)
- Hemangiopericytoma
chondrosarcoma Malignant fibrous histiocytoma Rhabdomyosarcoma 6.GERM CELL TUMORS.
Germinoma. Embryonal carcinoma. Yolk-sac tumor (endodermal-sinus tumor). Choriocarcinoma. Teratoma. Mixed germ cell tumor.
4.HEMATOPOIETIC NEOPLASMA
Malignant lymphomas(primary CNS lymphoma) Plasmacytoma
Grade II tumors:
Relatively slow growing Sometimes recur as higher grade tumors May be nonmalignant or malignant
Grade III
Malignant tumors Often recur as higher grade tumors
Grade IV
Highly malignant and aggressive
Grade 1 benign astrocytoma Grade 2 low-grade astrocytoma Grade 3 anaplastic astrocytoma Grade 4 glioblastoma multiformis
St. Anne/Mayo Grade Used for astrocytomas Uses four morphologic criteria
1.Nuclearatypia 2.Mitosis 3.Endothelial proliferation
St. Anne/Mayo Grade Grade 1 = 0 criterion Grade 2 = 1 criterion, usually nuclear atypia Grade 3 = 2 criteria, usually nuclear atypia and mitosis Grade 4 = 3 or 4 criteria
Headaches, vomiting (sometimes without nausea), altered state of consciousness (somnolence, coma), dilatation of the pupil on the side of the lesion (anisocoria), papilledema (prominent optic disc at the funduscopic eye examination)
small tumors obstructing the passage of cerebrospinal fluid (CSF) may cause early signs of increased intracranial pressure. Increased intracranial pressure may result in herniation (i.e. displacement) of certain parts of the brain, such as the cerebellar tonsils or the temporal uncus, resulting in lethal brainstem compression. In very young children, elevated intracranial pressure may cause an increase in the diameter of the skull and bulging of the fontanelles.
II)DYSFUNCTION : depending on tumor location, damage( it may have caused to surrounding brainstructures), either through compression or infiltration, any type of focal neurologic symptoms may occur, such as cognitive and behavioral impairment (including impaired judgment memory loss, lack of recognition, spatial orientation
personality or emotional
changes,
hemiparesis, hypoesthesia,
aphasia, ataxia,
visual field impairment, impaired sense of smell,
impaired hearing,
facial paralysis, double vision
Hemiplegia impairment to swallow. A bilateral temporal visual field defect (bitemporal hemianopiadue to compression of the optic chiasm), often associated with endocrine disfunction
either hypopituitarism or hyperproduction of pituitary hormones and hyperprolactinemia is suggestive of a pituitary tumor.
III)IRRITATION :
signs abnormal fatigue, weariness, absences and tremors, also epileptic seizures
Epi:
2nd most common primary brain tumor after gliomas, incidence of ~ 6/100,000 Usual age 40-70 F>M Arise from arachnoidal cap cell type from the arachnoid membrane Usually non-invasive Associated with NF-2 Parasagittal region Sphenoid wing Parasellar region Asymptomatic Symptomatic: focal or generalized seizure or gradually worsening neurologic deficit
MENINGIOMA
Facts:
Location:
Presentation:
Gliomas
Astrocytes- astrocytomas Fibrillary Pilocytic Oligodendrocytes- oligodendrogliomas Ependyma- ependymomas
GLIOMAS
Arise from Glial Cells
Astrocytomas
Astocytomas fall on a gradient that ranges from benign to malignant
Benign Low Grade Pilocytic Astocytomas Diffuse Low Grade Astrocytomas Malignant Glioblastoma multiforme
Oligodendrogliomas
ASTROCYTOMA
Diffuse Low Grade Astrocytoma
Epi:
15% of Astrocytomas Young Adults
Facts:
Widely Infiltrate surrounding tissue
Location:
Frontal Region Subcortical white matter
Cyst
Presentation:
Seizures Headache Slowly progressive neurologic deficits
T1 weighted T2 weighted
Facts:
Location:
May arise de novo or evolve from a low-grade glioma Tumor infiltrates along white matter tract and can cross corpus callosum Poor Prognosis Can look like a butterfly lesion
Frontal & Temporal Lobes Basal Ganglia Seizures, Headache Slowly progressive neurologic deficits
Presentation:
Astrocytomas
ADULTS Supratentorial Solid Malignant; fibrillary. CHILDHOOD Infratentorial Cystic Benign ; pilocytic ,
astrocytomas
OLIGODENDROGLIOMA
Epi:
5-10% of primary brain tumors Mean age of onset 40 years Facts: Distinguished pathologically from astrocytomas by the characteristic fried egg appearance. Arises from Myelin Location: Superficially in Frontal Lobes Presentation: Seizures most common Headache Slowly progressive neurologic deficits
Oligodendroglioma
GERMINOMA
Facts:
Germ Cell Tumors Causes Parinauds Syndrome
disorder characterized by fixed upward gaze
Location:
Commonly in Pineal Region (>50%) Overlies tectum of midbrain
Presentation:
Obstructive Hydrocephalus due to aqueductal stenosis
T1 Images
Epi
Facts
Represents 2% of gliomas One of the most common brain tumors in patients < 2 years of age; Benign tumor; Headache Hydrocephalus secondary to CSF overproduction Occur in decreasing frequency: 4th, lateral, and 3rd ventricles;
Presentation Location
Imaging
CEREBELLAR ASTROCYTOMA
Epi:
Most often occurs in childhood
Facts:
Most potentially curable of the astrocytomas
Location:
Posterior Fossa
Presentation:
Headaches Nausea/Vomiting Gait Unsteadiness Posterior head tilt with caudal tonsillar herniation
Cyst
Epi
MEDULLOBLASTOMAS
Represent 7% of primary brain tumors 2nd most common posterior fossa tumor in children 70% of patients are diagnosed prior to age 20 with peak incidence between 5-9 years of age;
Facts
Primitive neuroectodermal tumors (PNET)
Soft, friable tumors, often necrotic Can metastasize via CSF tracts Highly radiosensitive
Location
About 75% arise within the cerebellar vermis
Presentation
Most frequently present with signs of intracranial pressure May cause hydrocephalus Cranial nerve deficits may also occure
HEMANGIOBLASTOMA
Epi Facts
2% of primary intracranial tumors and 10% of posterior fossa tumors Most found in young adults and children Characterized by abundant capillary blood vessels If found in cerebellum and retina, may represent part of von Hippel-Lindau syndrome. Acute hemorrhage can be fatal 15-20% of patients with hemangioblastomas can present with erythrocytosis Usually present with neurologic deficits by direct compression or hemorrhage Neurologic deficits may include cerebellar ataxia, oculomotor nerve dysfunction, motor weakness, or sensory deficits
Presentation
Location
Epi
Accounts for 10% of CNS lesions; Male=Female Median age at diagnosis is 5 years old
EPENDYMOMAS
Imaging Usually well demarcated
with frequent areas of calcification,
Facts
Derived from primitive glia Overall survival at 10 years is 45-55%
Presentation
Most patients present with symptoms of increased intracranial pressure
Location
Typically arise within or adjacent to the ependymal lining of the ventricular system. In children, 90% are intracranial with 60% arising in posterior fossa (4th ventricle is the most common infratentorial site) Most common spinal cord glioma (in adults, 75% arise within spinal cord);;
BRAINSTEM GLIOMAS
Epi
Male=Female Account for 10-20% on all CNS tumors More common in children (account for 20% of all intracranial neoplasms under the age 15); In children, median age at diagnosis is 5-9 years of age.
Facts
NF-1 is the only known risk factor Mostly benign (but range from benign to very aggressive); Long term survival for low-grade gliomas is near 100%.
Location
In peds, 80% arise in pons, with 20% arise in medula, midbrain, and cervicomedulary junction;
BRAINSTEM GLIOMAS
Presentation
Most patients with low-grade brainstem gliomas have a long history of minor signs and symptoms; May present with neck pain or torticollis; Medulary tumors may present with cranial nerve palsies, dysphagia, nasal speech and apnea, n/v, ataxia,or weakness; May cause locked-in syndrome
Epi
SCHWANNOMAS
Facts
Female>male Median age at diagnosis is 50 Account for 80-90% of cerebellopontine angle tumors Comprise 8% of intracranial tumors in adults; rare in children (except with NF-2)
Presentation
Unilateral in 90% of cases (R=L); Bilateral acoustic neuromas are diagnostic of NF-2; Patients may present with asymmetric sensorineural hearing loss, tinnitus Fluctuating unsteadiness while walking, vertigo (although only 1% of patients with vertigo had schwannomas); If CN V nerve is affected, facial numbness, pain, and hyperesthesia may be present; If CN VII is affected, facial paresis may be present. Tumor progression may lead to compression of brainstem or cerebellum leading to ataxia, tonsil herniation, and hydrocephalus Arise from vestibular division of CN VIII; majority benign
Location
SCHWANNOMAS
PITUITARY ADENOMAS
Epi
Most common tumors of pituitary gland Represent 8% of primary brain tumors
Imaging:
Plain x-ray may show an enlarged sella turcica;
Facts
Out of pituitary adenomas, prolactinomas are the most common;
Presentation
May cause hypopituitarism and visual field defects; Patients should have endocrine, radiographic, and ophthalmologic assessments.
CRANIOPHARYNGIOMAS
Epi
Represent 1-3% of primary brain tumors Bimodal distribution: first peak infants and children; second peak 55-65 year old
Imaging
Cystic calcified parasellar lesion could be seen on radiograph;
Facts
Derived from epithelial remnants of Rathkes pouch; slow growing; benign Tend to recur even after complete removal 20-year survival rate of children with craniopharyngiomas is about 60%.
Location
Located in suprasellar fossa and inferior to optic chiasm
Presentation
Cause bitemporal hemianopsia and hypopituitarism; frequently present with headache;
thankyou