General Presentation:
- Secondary brain tumors; metastasis: Lung, breast, melanoma, renal cell, colorectal
- Mass effect: mainly by slow-growing tumors like meningioma
- Local invasion: mainly by aggressive primary tumors
- Headache: on awakening (hyperventilating during sleep -> CO2 accumulates -> vasodilation)
- Seizure: should be a cortical lesion (supratentorial)
Astrocytoma:
1. Pilocytic astrocytoma: Grade 1 astrocytoma
- In children & young adults
- Most commonly in cerebellum + diencephalon (optic chiasm, hypothalamus)
- CT\MRI: cystic lesion + enhanced mural nodule
- Treatment -> surgery, good outcome
2. Low grade glioma: Grade 2 astrocytoma
- Peak in 30’s
- Most common sx: seizure, so give antiepileptics, if coming to ED -> steroids
- Hypo in T1, hyper in T2, no enhancement
- If contrast enhancement -> malignant transformation
- Natural Hx:
- Remains low grade many years, survival = 9 yrs
- Might progress to higher grade, but we don’t know when, so observe
3. Glioblastoma multiform (GBM): Grade 4 astrocytoma
- Most common supratentorial tumor in adults
- Causes:
- De novo
- De-differentiation of lower grade glioma
- CT: irregular enhancement + central hypodensity (necrosis)
- MRI: severe midline shift and edema, “butterfly”
- Why biopsy? Mimics TB
- Goal of treatment: prolongs quality of survival

4. Sub ependymal giant cell astrocytoma: Grade 1 astrocytoma
- In tuberous sclerosis
- Most commonly in lateral ventricles -> hydrocephalus
Oligodendroglial Tumors:
1. Oligodendroglioma (grade 2)
2. Anaplastic oligodendroglioma
- Do chromosomal analysis of the tumor -> if mutations in chr 19 + 1 -> respond well to chemo
Ependymal Tumors:
1. Ependymoma:
- Third most common tumors in children
- Can be infratentorial (> 2 yrs), supratentorial (< 2 yrs)
- Most commonly in post fossa, why? They arise from ependymal cells lining 4th ventricle -> hydrocephalus
- Treatment -> surgery
Choroid Plexus Tumors:
1. Choroid plexus papilloma: grade 1
- Adults; 4th ventricle, children; lateral ventricles -> hydrocephalus
- CT: dilated ventricles + lobulated tumor inside
2. Choroid plexus Carcinoma: grade 3-4
Pineal Tumors:
- Presentation:
- Hydrocephalus
- Parinaud’s syndrome (upward gaze palsy)
- Precocious puberty
- Work up:
- MRI: enhanced lesion, calcification, hydrocephalus
- Serum markers -> AFP, HCG, CL
- Management -> third ventriculostomy + biopsy
Medulloblastoma:
- Embryonic tumor
- Most common malignant pediatric brain tumor
- Most commonly in post fossa -> N\V -> easily missed -> pt can die
- Cerebellar tumor only
- Tends to metastasize -> CSF seeding -> lumbar spine
- Treatment: surgery + radio\chemo
Vestibular Schwannoma:
- From 8th cranial nerve -> hearing loss, tinnitus, vertigo
- Usually unilateral, if bilateral -> pathognomic of NF type 2
- Most commonly -> cerebellopontine angle (CPA)
Meningioma:
- Most common non-glial primary tumor + most common extra-axial primary CNS tumor -> can be found incidentally
- Female predication (esp in spine)
- Slowly growing lesion
- Arise from arachnoid villus
- Doesn’t infiltrate brain tissue
- Radiology:
- Attached to dura -> dural tail
- Hyperostosis of overlying skull
Pituitary Tumors:
- Ant pituitary (adenohypophysis) -> location of pituitary tumor itself
- Post pituitary (neurohypophysis) -> location for metastasis
- Closest structure to the pituitary? 6th (abducent) -> first to attack when expanding
- Presentation:
- Hyperfunctioning
- Mass effect -> bitemporal hemianopia
- Investigations:
- Brain MRI
- Hormonal profile
- Visual acuity
- Surgery -> transphenoidal
Pituitary Apoplexy:
- Pituitary tumor -> infarction or hemorrhage -> sudden expansion -> severe headache and visual changes
- Risk factors: pregnancy
- Treatment: prompt steroids
Download the PDF version: here
References:
- Dr Aloraidi’s lecture