brain tumors د.عبدالرحمن سلام
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BRAIN OEDEMA AND DISORDER OF I.C.T
Brain oedema
Definition : Increase in brain volume due to an
increase in water and sodium content
Classification
1-Vasogenic (extra cellular): Increase capillary
permeability lead to increase extra cellular fluid
which as plasma &plasma protein caused by e.g.
brain tumours,abscess ,infection ,trauma and
haemorrage..
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2-Cytotoxic(cellular): Decrease capillary
permeability lead to increase intracellular fluidwhich as water and sodium caused by hypoxia,
hypo osmalarity e.g. water intoxication.
3- Interstitial (hydrocephalic): Increase brain
fluid especially extra cellular due to block C.S.F
absorption caused by obstructive hydrocephalus
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Hydrocephalus
Definition : Increase cerebrospinal fluid (C.S.F )
volume and dilatation of the cerebral ventriclesClassification :
1- Obstructive: Due to congenital malformation ,
post-inflammatory ,post- hemorrhagic and mass
lesion
2- Communicating : Due to overproduction ofC.S.F, defective absorption of C.S.F. and
insufficiency of venous drainage .
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BRAIN TUMERS
A- Supratentorial:
1- Meningioma: Supposed to be arise from
arachnoidal tissue and frequently near the venous
sinuses it has a tendency to become calcified
(psammoma) this type of tumors characteristically
infiltrates the skull but compress the brain .
The common site of tumors is :
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1-Parasagital areas
2-Lateral surface of temporal lobe
3-Sphinoidal ridge
4-Olfactory groove
5-Suprasellar
6-Cerebropontin angle
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2- Craniopharyngioma: Arise from congenital
remnants of rasthke`s pouch common site issuprasellar and age of onset 10-30 Y
3- Cholesteatoma: It is epidermoid which arises from
congenital remnants of cells the common site
cerebropontinangel (C.P.A) and temporal lobe
4- Astrocytoma: (most common glioma) It arise fromastrocyte the cerebellum common site in children and
cerebral hemisphere in adult .
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5- Oligodendroglioma: Rare type of glioma and
occipital lobe its common site
6- Ependymoma: Aris from ependymal cell its
common site vermis of cerebellum and floor of fourth
ventricles lead to increase I,C.T
7- Glioblastoma multiform : Highly malignant
glioma it common site cerebral hemisphere and rare
in the occipital region.
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8- Spongioblastoma polar: Pones and opticchiasma are the common sits
9- Pineal body tumors : Midbrain is the common
sit lead to endocrinal disturbances
10-Tumors of pituitary gland .
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B- Infratentorial tumors:
1- Medulloblastoma: Occure mostly in children
before age of 10 years it arises from
undifferentiated cell rests in the vermis or in the
posterior modularly velum which form the roof of
the fourth ventricle ,lead to increase intracranial
tension and ataxia
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2-Cerebellar astrocytoma: located in the
cerebellar hemisphere when it occurs in children
3-Cerebellar angioblastoma: Arises from
embryonic vascular cells and it is frequently
located on one cerebellar hemisphere .
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4- Acoustic neuroma: Commonly located in
cerebello- pontin angle which a benign tumor arises
from the sheath of the vestibular branch of the
auditory nerve inside the internal auditory meatus.
The tumor may occur in middle age when it is usually
single or it may develop in young age when it is
frequently multiple .
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Clinical diagnosis of tumors
General:
1- Headache: It is the first symptom in 35% of
patients and occurs later in 70% morning
headache or those that waken the patients from
sleep.
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2- Vomiting or nausea: Due to increase I.C.P
involvement of the chemoreceptor trigger zone in
the medulla may lead to projectile vomiting.
3- Facial pain: Due to distribution of the trigeminal
nerve with tumors at the base of the skull.
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4- Seizures: Are the first symptom in 30%of brain
tumors and brain tumors account for only 5% of all
patients with epilepsy. Slowly growing tumors and
those in the rolandic fissure tend to be the most
epileptogenic. The association between brain
tumors and seizures increase with age.
5- Alteration in consciousness : May be evident
in 20% of patients at the time of diagnosis and
vary from subtle personality changes to confusion
to coma.
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Focal symptoms and signs :
1- Frontal lobe: Are initially silent, with time there
may be personality change, impaired judgment
and gait abnormalities.
2-Temporal lobe : Seizure which range from
simple olfactory hallucination, feeling of fear tocomplex partial seizure.
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3- Parietal lobe:loss cortical sensation and
hemiparesis .
4- Occipital lobe : Visual field change .
5-Thalamic: Contralateral sensory loss, cognitive
changes and rarely aphasia .
6- Brain stem: Cranial nerve disturbances .
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7- Pineal body: Signs and symptoms of increase
I.C.P. and precocious puberty
8- Intraventricular: Hydrocephalus and increase
I.C.P.9- Cerebellar: Headache and ataxia.
10- Skull base: Affect cranial nerve
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False localizing signs :
may arise from increase I.C.P. the most common is :
1- Sixth cranial nerve due to compression of
abducent nerve over petrous ridge.
2- Ipsilateral hemiparesis: Due to compression of
contralateral cerebral peduncle against tentorium .
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3- Bitemporal hemianopia: Due to compression
optic chiasma at lateral side
4- Giat abnormalities
5- Endocrinal deficit
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Diagnosis:
Careful history and neurological examination,C.T scan & brain M.R.I with & without contrast.
Treatment:
Surgical resection partial or complete
radiotherapy and or chemotherapy.
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