132 Neuro: Neoplasms & how to be a better student

• Most common benign intracranial tumor; originates from meninges (arachnoid cells)



• Slow-growing, frequently calcified

Clinical Presentation

• Often asymptomatic or gradual-onset headaches, seizures, focal deficits

Labs, Studies, and Physical Exam Findings

• MRI: extra-axial lesion with dural attachment (“dural tail sign”)



• CT: often calcified

Treatment

• Surgical resection if symptomatic; observation if incidental

• Originates from Schwann cells, commonly affects CN VIII at cerebellopontine angle

Clinical Presentation

• Progressive unilateral hearing loss, tinnitus, balance issues



• Possible facial nerve involvement (CN VII)

Labs, Studies, and Physical Exam Findings

• MRI: enhancing lesion at cerebellopontine angle

Treatment

• Surgical resection, stereotactic radiosurgery, or observation if small

• Benign anterior pituitary tumor; may be hormone-secreting or nonfunctional

Clinical Presentation

• Endocrine abnormalities (prolactinoma, acromegaly, Cushing’s disease)



• Bitemporal hemianopsia from optic chiasm compression

Labs, Studies, and Physical Exam Findings

• MRI: sellar mass compressing optic chiasm



• Hormone level assessment (prolactin, GH, ACTH)

Treatment

• Prolactinoma: Dopamine agonists (Cabergoline)



• Surgical resection if visual or hormonal disturbances

• Most common and aggressive primary CNS malignancy; Grade IV astrocytoma

Clinical Presentation

• Rapid onset and progression of headaches, seizures, focal deficits, cognitive changes



• Increased ICP: nausea/vomiting, papilledema

Labs, Studies, and Physical Exam Findings

• MRI: irregular, infiltrative lesion with central necrosis (“butterfly” glioma crossing corpus callosum) and extensive edema

Treatment

• Surgical debulking, radiation, chemotherapy (Temozolomide)



• Prognosis poor (median survival 12-15 months)

• Malignant pediatric brain tumor located in cerebellum; commonly in posterior fossa

Clinical Presentation

• Symptoms due to obstructive hydrocephalus: headache, vomiting, ataxia, gait instability



• Increased ICP: papilledema, altered mental status

Labs, Studies, and Physical Exam Findings

• MRI: enhancing mass in posterior fossa; obstructive hydrocephalus

Treatment

• Surgical resection, radiation, chemotherapy



• Prognosis varies with subtype and resection completeness

• Aggressive malignancy primarily affecting immunocompromised patients (HIV/AIDS, post-transplant)

Clinical Presentation

• Rapid cognitive decline, focal neurological deficits, seizures



• May present with constitutional “B symptoms” (fever, weight loss, night sweats)