CNS+Neoplasms

//Western Diagnosis// A. brain tumors B. CNS changes from invasion and destruction by tumor and from secondary effects like inc intracranial pressure C. found in 2% of routine autopsies D. most common in early adulthood or middle life E. severity depends on size, location, rate of growth, grade of malignancy F. benign grow more slowly with no necrosis or vascular proliferation 1. may reach considerable size before causing sx 2. if cannot be excised entirely, lethal due to size G. malignant have rapid growth, necrosis, vascular proliferation, and endothelial hyperplasia 1. rarely metastasize out of CNS 2. death by large local growth

Signs & Symptoms
1. general sx from inc intracranial pressure: HA, V, papilledema, mental sx 2. convulsive seizures: may precede other sx by months or years 3. mental sx ---initial sx in 25% of all malignant brain tumors ---may appear at any time ---drowsiness, lethargy, obtuseness, personality changes, disordered conduct, impaired mental faculties, psychotic episodes 4. focal sx ---depend on location ---from localized destruction or compression, or altered endocrine function

Diagnosis
1. suspect in pts with the following: slowly progressive sns of focal cerebral dysfunction, convulsions, HA of recent onset with no response to tx, sx of inc intracranial pressure (V, papilledema) 2. complete neuro exam 3. chest x-rays 4. CT scan 5. MRI

Treatment
1. depends on type and location of tumor 2. surgical excision 3. radiation 4. chemotherapy only in a few selected types