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
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]
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]
A headache is regarded as one of the most common complaints, presumably as a consequence of growing intracranial pressure and hydrocephalus. [symptoma.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]
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]
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]
This 2 year old boy presented with a short history (one to two months only) of lower limb weakness, difficulty swallowing and signs of a respiratory tract infection. The sagittal T1 MR below shows a tumor (#1) expanding the medulla oblongata. [pedsoncologyeducation.com]
For example, if you have a tumor near the part of your brain that controls your arm or your eyesight, your symptoms may include limb weakness or blurry vision, Dr. Schwartz says. [prevention.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]
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   .
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