Brain stem neoplasm comprises a very small fraction of all cranial tumors and gliomas are the predominant form. Depending on the location of the neoplasm, patients might present with various symptoms, including headaches, cranial nerve palsies, weakness of the limbs, gait disturbances, and visual deficits. The diagnosis is made through a comprehensive clinical assessment followed by imaging studies such as magnetic resonance imaging (MRI) and MR spectroscopy, whereas a biopsy can sometimes be used to confirm the exact type of tumor.
Because a brain stem neoplasm is defined as a lesion occurring anywhere in the medulla oblongata, the pons, or in the midbrain , the clinical presentation of cases with this condition can significantly vary. These tumors seem to be more common in infants than in adults, with a mean onset at 6-7 years of age and a very poor prognosis . In adults, the majority of cases are discovered in the fourth decade of life    . A headache is regarded as one of the most common complaints, presumably as a consequence of growing intracranial pressure and hydrocephalus . Other common findings include palsies of various cranial nerves (whose nuclei originate from the brainstem, such as the trigeminal, abducens, facial, and vestibulocochlear nerve), but the facial nerve is most frequently affected   . Myokymia, hemifacial spasms, or a long history of facial palsy is not uncommon in the affected population . Deficits of gait and limb function, as well as diplopia, are important manifestations of a brain stem neoplasm   . Some studies emphasize that patients typically report with unilateral facial symptoms and contralateral limb deficits . The prognosis is generally poor, with overall survival being about 12 and 32 months for the pediatric and adult gliomas, respectively  .
Entire Body System
- Weight Loss
For obese patients, weight loss is also needed. This is a slowly-growing fluid-filled cyst, thought to be left over from the fetal stage. [aans.org]
loss or weight gain Treatment Surgery is the standard treatment when possible. [braintumor.org]
With metastases, weight loss is common. Symptoms worsen over time unless the tumor is treated. With treatment, particularly for benign tumors, some people completely recover. For others, life span is shortened, sometimes greatly. [merckmanuals.com]
India Source of Support: None, Conflict of Interest: None PMID: 12215704 Keywords: Brain Edema, diagnosis,etiology,therapy,Brain Neoplasms, complications,diagnosis,Drainage, methods,Female, Human, Hydrocephalus, diagnosis,etiology,therapy,Intracranial Hypertension [jpgmonline.com]
- Heart Failure
Failure and Transplantation Cardiology Nita Ahuja MD, MBA Gastrointestinal Surgical Oncology, General Surgery, Minimally Invasive Surgery, Sarcoma and Connective Tissue Surgical Oncology Paul Aiello MD Radiology, Diagnostic Radiology Joseph Akar MD, [yalemedicine.org]
Symptoms include loss of balance, tinnitus, total hearing loss, facial pain or numbness, and headache. Surgery is the standard treatment. Pseudotumor Cerebri This condition is not a brain tumor, but its symptoms mimic a brain tumor. [braintumor.org]
Tinnitus, a buzzing or ringing sound, may also be present; other symptoms are also possible. The tumor is benign, grows slowly and is treated with surgery or radiosurgery. It is also known as an acoustic neuroma. [aans.org]
28.8%), impaired coordination (28.8%), paresis (21.2%), pain (21.2%), gait ataxia (18.3%), dysarthria and dysphagia (13.5%), signs of raised intracranial pressure (12.5%), organic psycho-syndrome (7.7%), nausea and vomiting (6.7%), myoclonus (2.9%), tinnitus [bmccancer.biomedcentral.com]
Some of the most common are Headaches, often in the morning Nausea and vomiting Changes in your ability to talk, hear, or see Problems with balance or walking Problems with thinking or memory Feeling weak or sleepy Changes in your mood or behavior Seizures [icdlist.com]
The symptoms of a malignant brain stem neoplasm include dizziness, breathing problems, headaches, nausea, and ataxia. [novusbio.com]
A headache is regarded as one of the most common complaints, presumably as a consequence of growing intracranial pressure and hydrocephalus. [symptoma.com]
Headaches are often the most common symptom. But only very rarely do children with headaches have a tumor. [medlineplus.gov]
Based on its location in the brain, a cyst can cause symptoms such as headache, pain, seizures, or a neurological deficit. Cysts can be surgically removed or drained. [braintumor.org]
- Cranial Nerve Involvement
On average symptoms are present for 10.6 months prior to diagnosis and cranial nerve involvement is only seen in 29%. Most Common Signs of Brain Stem Glioma: Palsy of the soft palate Facial palsy Pyramidal weakness. [pedsoncologyeducation.com]
Intra-axial schwannoma is difficult to distinguish from the main differential diagnosis of glioma a priori, particularly in the absence of cranial nerve involvement. [ajnr.org]
nerve involvement (commonly IX and X) Long tract signs Ataxia Downbeating nystagmus and oculomyoclonus (medullary involvement) See Clinical Presentation for more detail. [emedicine.medscape.com]
- Cranial Neuropathy
Clinical features include ATAXIA, cranial neuropathies (see CRANIAL NERVE DISEASES), NAUSEA, hemiparesis (see HEMIPLEGIA), and quadriparesis. Primary brain stem neoplasms are more frequent in children. [connects.catalyst.harvard.edu]
neuropathies. 33 Similar to OPGs, NF1-associated brainstem gliomas are more indolent than those not associated with NF1 and most often do not require clinical intervention. 2,36 Figure 2 demonstrates an expansive lesion in the cervico-medullary region [rarediseasesjournal.com]
As herniation progresses there is a pattern of rostro-caudal deterioration of neural functions, which is discussed further in the chapter on stupor and coma ( Chapter 17 ). [dartmouth.edu]
- Trigeminal Neuralgia
Petroclival tumors can compress the trigeminal nerve, resulting in sharp pain in the face (trigeminal neuralgia) or spasms of the facial muscles. [brighamandwomens.org]
The diagnostic workup starts with a meticulous clinical evaluation that focuses on the onset of signs, their duration, as well as progression and severity. A detailed patient history may reveal sufficient information to localize the area from where symptoms develop and with a full neurological examination, a preliminary diagnosis can be made. To confirm a brain stem neoplasm, however, imaging studies need to be employed. MRI of the endocranium is the most valuable study for the assessment of brain tumors . Crucial findings on MRI are diffuse enlargement, hyperintense signals on T2-weighted images and fluid attenuation inversion recovery (FLAIR) studies, and hypointense signals on T1-weighted images . The use of gadolinium as a contrast is of limited efficacy due to the widely infiltrative nature of the tumors that develop in this part of the brain . The pons seems to be the main location where brain stem neoplasms are found   . Fluorodeoxyglucose-positron emission tomography (FDG-PET) and MR spectroscopy have been described as possibly useful modalities for discriminating different tumor types solely on radiographic findings  . When the lesion exhibits inconclusive findings, a biopsy may be performed as a definite diagnostic tool, although significant risks exist when carrying out this procedure   .
Treatment options include watchful waiting, surgery, radiation therapy, chemotherapy, and targeted therapy. Targeted therapy uses substances that attack cancer cells without harming normal cells. Many people get a combination of treatments. [icdlist.com]
This case demonstrates that for discrete brainstem lesions the differential diagnosis includes entities other than glioma for which treatment is available. Biopsy sampling should be considered when technically feasible. [ncbi.nlm.nih.gov]
Treatments of brain stem neoplasms depend on the severity and type of tumor, and since the brain stem is so crucial to survival, surgery is only done when absolutely necessary, and depending on the phase of the malignant neoplasm, may be a fruitless effort [novusbio.com]
Treatment Options for Childhood Brain Stem Glioma For information about the treatments listed below, see the Treatment Option Overview section. [cancer.gov]
Surgery is the standard treatment. [braintumor.org]
The prognosis is generally poor, with overall survival being about 12 and 32 months for the pediatric and adult gliomas, respectively. [symptoma.com]
Prognosis diffuse terrible prognosis 90-100% patients die within 2 years of diagnosis 6 focal (tectal glioma) excellent long-term survival with CSF shunting (essentially benign lesions) focal (other) good long-term prognosis with surgery (dorsally) exophytic [radiopaedia.org]
Treatment and prognosis [ edit ] Treatment typically consists of radiotherapy and steroids for palliation of symptoms. [ citation needed ] (Proton Beam Therapy should be included here by someone with good knowledge of it; it is more accurate, and very [en.wikipedia.org]
Focal brain stem glioma, however, can carry an exceptional prognosis, with long-term survivals frequently reported. [childhoodbraintumor.org]
Increasing tumor grade is associated with poorer prognosis. Molecular profiling is now an important part of glioma classification. An IDH1 mutation carries a significantly improved prognosis over the IDH1 wildtype, no matter the tumor grade. [emedicine.medscape.com]
India Source of Support: None, Conflict of Interest: None PMID: 12215704 Keywords: Brain Edema, diagnosis,etiology,therapy,Brain Neoplasms, complications,diagnosis,Drainage, methods,Female, Human, Hydrocephalus, diagnosis,etiology,therapy,Intracranial [jpgmonline.com]
Clinical Clues to Nonmalignant Brain Lesions Clinical clues Suggested etiology Abnormalities found on more extensive imaging that are suggestive of an etiology Cysticercosis, fungal infections, sarcoidosis, tuberculosis Chronic fever; recent dental procedure [aafp.org]
How much of this variation is due to artifactual influences or etiologic differences has been the subject of many debates. Some reports have suggested a slight male preponderance, whereas others have failed to observe any sex predilection. [emedicine.medscape.com]
In some instances, however, the symptoms are specific to the etiology. Hemorrhage, which can be parenchymal or extra-axial is the most common cause of intracranial mass lesions and is discussed in Chapter 27. [dartmouth.edu]
Neuroradiological findings of the preoperative MRI were analyzed for etiological classification. Central neuroradiological review was not performed to depict daily clinical practice. [bmccancer.biomedcentral.com]
Other factors that have been shown to negatively influence survival include contrast enhancement within the tumor on MRI, location within the brainstem (pons medulla midbrain), and advanced age ( 60 years). [2, 7] Epidemiology Race-, sex-, and age-related [emedicine.medscape.com]
Evaluation of epidemiologic evidence for primary adult brain tumor risk factors using evidence-based medicine. Prog Neurol Surg. 2006;19:54–79. 6. Ostrom QT, et al. [aafp.org]
Authors’ Affiliations (1) Department of Neurosurgery, Schwabing Academic Teaching Hospital, Munich, Germany (2) Service de Neurochirurgie, Hopital Louis Pasteur, Colmar, France (3) Institute for Medical Informatics, Statistics and Epidemiology, University [bmccancer.biomedcentral.com]
Anatomic location determines the pathophysiological manifestation of the tumor. With tectal lesions, hydrocephalus may occur as a result of fourth ventricular compression. [emedicine.medscape.com]
As befits a diagnosis that encompasses an array of pathophysiologic alterations, the radiographic appearance of adult brainstem glioma varies widely, with approximately 40% demonstrating enhancement ( 3, 5 ). [frontiersin.org]
As the tumour increases in size, the supratentorial pressure build-up increases and prevents as much as possible the encroachment of the brainstem and hypothalamus. [jpgmonline.com]
[…] shrink the tumor or prevent the tumor from growing back Comfort measures, safety measures, physical therapy, occupational therapy, and other such steps may be required to improve quality of life. [medlineplus.gov]
Nothing specific can be done to prevent the development of cysts. Treatment The type, size, and location of the cyst determine how it will be addressed. [abta.org]
Our state-of-the-art stem cell transplant facility is designed specifically for children and teens undergoing stem cell transplant — minimizing their exposure to harmful toxins and germs without preventing their freedom to leave their room or interact [dana-farber.org]
[…] and prevent seizures associated with brain tumors) ventriculoperitoneal shunt (Also called a VP shunt.)- a VP shunt may be placed in the head to drain excess fluid from inside the brain to the abdomen. [urmc.rochester.edu]
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- Treglia G, Muoio B, Del Ciello A, Bertagna F. Usefulness of 18F-FDG-PET/CT in Evaluating a Brainstem Glioma in an Adult Patient with Neurofibromatosis Type 1. Nucl Med Mol Imaging. 2013;47(3):212-213.
- Guillamo JS, Monjour A, Taillandier L, et al. Brainstem gliomas in adults: prognostic factors and classification. Brain. 2001;124:2528–2539.
- Grimm SA, Chamberlain MC. Brainstem glioma: a review. Curr Neurol Neurosci Rep. 2013;13(5):346.