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Frontal Lobe Neoplasm

Neoplasm of Frontal Lobe of Brain

A frontal lobe neoplasm might present with an array of symptoms that are collectively included in the "frontal lobe syndrome". Personality and abrupt emotional changes (aggression, apathy, impulsive behavior), and an overall decline of the functions for which the frontal lobe is crucial - planning, judgment, attention, memory, concentration- are some of the main findings. The diagnosis can be made through a detailed clinical investigation, followed by imaging studies, such as computed tomography (CT), but more commonly magnetic resonance imaging (MRI).


Presentation

The clinical presentation of a frontal lobe neoplasm comprises various symptoms related to the tasks that the frontal lobe is responsible for - planning, organization, critical thinking, and most importantly, cognition [1] [2] [3] [4]. The term "frontal lobe syndrome" is often used to depict the signs and symptoms observed in these patients [2] [3]. Personality and mood changes are one of the most prominent findings in the setting of a frontal lobe neoplasm and manifest as uncharacteristically impulsive behavior, bouts of aggression, hypersexuality, apathy, or a combination of all [1] [3] [4] [5]. Depression, paranoia, and/or mania is commonly encountered patients with frontal lobe neoplasms [1] [2] [3] [4] [5]. Loss of memory and/or focus, withdrawal from social life, and a reduced capacity for judgment are other notable signs of frontal lobe dysfunction [3]. Some authors have established that specific symptoms arise as a result of damage to specific areas of the frontal lobe [2] [3]. Namely, behavioral and personality deficits are most likely to occur if the prefrontal cortex is damaged, whereas cognitive dysfunction is highly indicative of an ongoing process in the dorsolateral region of the frontal lobe [2] [3]. Loss of the sense of smell (anosmia) is another important sign that must include frontal lobe tumors in the differential diagnosis, particularly in the presence of behavioral or cognitive symptoms [6] [7].

Fatigue
  • In rare cases, stereotactic surgery causes fatigue and a few episodes of mild headaches. Driving instructions – In some cases, patients may be advised not to drive a vehicle for a period of time.[brain-surgery.com]
  • I realize now that it is probably a direct result of fatigue. I find this so frustrating as I want to get back to my old self. I realize though that that probably isn't going to happen.[braintumour.ca]
  • People with brain tumours often feel fatigued for a variety of reasons and being tired can affect your ability to memorise or remember things. Likewise, get a good amount of sleep (6-8 hours) to help with this.[thebraintumourcharity.org]
  • Tumors in the diencephalon region may cause headaches, fatigue, weakness of the arms and legs, vision problems, and hormonal imbalances. Tumors in the cerebellum may cause headaches, changes in personality or behavior, and balance problems.[rarediseases.org]
Weight Loss
  • Both specific (anosmia, apraxia, and personality or cognitive deficits) and nonspecific (weight loss, improper sleep, anorexia, etc.) signs can point to an underlying process in the brain, providing sufficient evidence to employ imaging studies.[symptoma.com]
Anosmia
  • Loss of the sense of smell (anosmia) is another important sign that must include frontal lobe tumors in the differential diagnosis, particularly in the presence of behavioral or cognitive symptoms.[symptoma.com]
  • Headache Visual changes Nausea Vomiting Mental changes Lethargy Behavior changes Seizures Hemiparesis, hemiplegia Incoordination Ataxia Anosmia (inability to smell) Papilledema (optic disc swelling, ICP) Sensory impairments Cranial n. palsies Language[quizlet.com]
Impulsivity
  • Personality and abrupt emotional changes (aggression, apathy, impulsive behavior), and an overall decline of the functions for which the frontal lobe is crucial - planning, judgment, attention, memory, concentration- are some of the main findings.[symptoma.com]
Seizure
  • Full ROM Active when possible Optimal cardiopulm func Eventual independent bed mobility, transfers, ADLs, and ambulation Headaches Vomiting Blurred vision Seizures[quizlet.com]
  • It is common for low grade glioma to present with seizures, however it’s uncommon for it to present with nonepileptic seizures.[austinpublishinggroup.com]
  • New-onset seizures likewise require immediate medical care.[livestrong.com]
  • Prognosis is excellent, however, due to the difficulty in managing seizure medically, patients usually undergo resection and even in cases of incomplete resection, seizures frequently cease.[radiopaedia.org]
  • Two weeks later he had his first generalized seizure, and continued to have about one seizure per week. His seizures were not well-controlled on phenytoin.[path.upmc.edu]
Headache
  • […] fx for ages 50-60 Rapidly progressive symptoms: - unilateral headache followed by general headache - increased ICP - seizures - lethargy - memory loss - motor weakness - personality changes What is the survival rate for low grade astrocytomas w/ full[quizlet.com]
  • (Image: Purestock/Purestock/Getty Images) Though most people with headaches do not have brain tumors, headache is an initial symptom in about 20 percent of people with tumors, and up to 60 percent will develop headaches, according to "Neurology in Clinical[livestrong.com]
  • Less common after effects include nausea and headaches. In rare cases, stereotactic surgery causes fatigue and a few episodes of mild headaches.[brain-surgery.com]
  • It is common for low grade glioma to present with nonfocal neurological complaints, such as seizures or headaches; but it is uncommon for patients with low grade glioma to have nonepileptic seizures as the initial presentation.[austinpublishinggroup.com]
  • Headaches are effectively treated with the water cures protocol. Mental fog, depression, insomnia, and speech are all improved with the unprocessed salt and water. Once we re-hydrate our bodies, they can function better.[watercures.org]
Confusion
  • […] of the legs at night associated with transient confusion and headache the next morning.[austinpublishinggroup.com]
  • A man is standing by his confused wife. (Image: Dean Mitchell/iStock/Getty Images) The frontal lobe serves many important functions. Depending on the tumor's size and location, its effects will vary.[livestrong.com]
  • […] a brain tumor, which depend on the size, location, and rate of growth, may include frequent and severe headaches; unexplained nausea and vomiting; vision problems; loss of sensation or movement in arms or legs; balance, speech, or hearing problems; confusion[fortherecordmag.com]
  • Headache Insomnia Drowsiness Changes in Personality Confusion Depression Easily Irritable Impaired judgement Loss of Vision Decreased heart and respiratory rate Communication problems Slurred speech Seizures Short-term memory loss With the water cures[watercures.org]
  • Some of these symptoms are common even without a brain tumour, and this can cause confusion in the early stages. The brain The brain is contained within the skull, which protects it.[nhsinform.scot]
Personality Change
  • Other symptoms include mood or personality changes, weakness, speech problems or blurred vision. With a spinal cord astrocytoma, weakness or clumsiness of the arms or legs, gait, bowel or bladder problems may be reported.[aans.org]
  • The most common symptoms are seizures, headaches, and personality changes. Other symptoms vary by location and size of the tumor.[abta.org]
  • Other symptoms can include seizures, memory loss, physical weakness, loss of muscle control, visual symptoms, language problems, cognitive decline, and personality changes. These symptoms may change, according to which part of the brain is affected.[webmd.com]
Papilledema
  • Headache Visual changes Nausea Vomiting Mental changes Lethargy Behavior changes Seizures Hemiparesis, hemiplegia Incoordination Ataxia Anosmia (inability to smell) Papilledema (optic disc swelling, ICP) Sensory impairments Cranial n. palsies Language[quizlet.com]

Workup

The first and most important step of the diagnostic workup is a complete clinical assessment. A properly obtained patient history that determines the presence of even minor neurological deficits and a thorough physical examination that identifies these changes are sufficient to make a presumptive diagnosis. Both specific (anosmia, apraxia, and personality or cognitive deficits) and nonspecific (weight loss, improper sleep, anorexia, etc.) signs can point to an underlying process in the brain [1], providing sufficient evidence to employ imaging studies. CT and MRI are very useful for macroscopic evaluation of the brain and allow for the identification of a frontal lobe neoplasm in a short period of time [1]. A CT scan is more feasible and is accompanied by less risk for patients compared to an MRI scan, but the latter is superior in visualizing neoplastic changes, particularly in the white matter [1]. Although larger studies promote the argument against routine neuroimaging studies in the case of psychiatric changes that may include a brain tumor in the differential diagnosis, the physician is obliged to think of a possible organic cause of such symptoms, one of them being a neoplasm [1] [8]. For further testing, MR spectroscopy, functional MRI (fMRI), positron emission tomography (PET), or single-photon emission computed tomography (SPECT) imaging may be used [1].

Treatment

  • How successful is meningioma treatment? Eighty percent of patients reported satisfaction with the quality of their lives after undergoing treatment.[brighamhealthhub.org]
  • They may spread to other parts of the brain or into the spinal cord, and treatment must include the whole of this. Treatment Because there are different types of brain tumours, treatment will not be the same for everyone.[nhsinform.scot]
  • Treatment for High-Grade Astrocytomas Treatment for high-grade astrocytomas (Grade III anaplastic astrocytomas or Grade IV glioblastomas multiforme) is surgery, if possible.[webmd.com]
  • The standard treatments are administered five days a week, for six weeks.[aans.org]
  • Learn more about different treatment options for brain tumors on our Treatment page . Treatments for newly diagnosed and recurrent, low-grade or high-grade oligodendrogliomas are currently being studied in clinical trials.[abta.org]

Prognosis

  • Prognosis "Prognosis" is the medical term for a prediction of life expectancy. Keep in mind that these predictions are estimates.[abta.org]
  • What’s the Prognosis for Those With Gliomas? High-grade gliomas are fast-growing tumors. with a poor prognosis, especially for older patients.[webmd.com]
  • Prognosis is excellent, however, due to the difficulty in managing seizure medically, patients usually undergo resection and even in cases of incomplete resection, seizures frequently cease.[radiopaedia.org]
  • Prognosis This depends on the underlying pathology.[patient.info]
  • Julie's Epilogue: Julie became one of our clients and although she was given a poor prognosis and no hope, she responded well and is a happy, healthy and now feeling mother at this writing, several years later.[watercures.org]

Etiology

  • Certain conditions have both an underlying etiology and multiple body system manifestations due to the underlying etiology.[icd10coded.com]
  • The etiology of these ‘tumors’ is not certain and the current acquaintance of the pathophysiology of this disease is based on an abnormal response by the myofibroblast to trauma, tissue injury, surgery, inflammation and so on.[cnjournal.biomedcentral.com]

Epidemiology

  • Epidemiology Prevalence It was found in 19% of people aged 85years in one study. [ 2 ] There may be significant under-reporting due to the nature of the condition.[patient.info]
Sex distribution
Age distribution

Pathophysiology

  • The etiology of these ‘tumors’ is not certain and the current acquaintance of the pathophysiology of this disease is based on an abnormal response by the myofibroblast to trauma, tissue injury, surgery, inflammation and so on.[cnjournal.biomedcentral.com]

Prevention

  • Measures such as neck compression (tourniquet) and volume loading can be helpful in preventing VAE. PEEP increases the risk of VAE.[openanesthesia.org]
  • Prevention Because the cause or causes of oligodenrogliomas are not known, there are no known preventions. Special concerns Repeat surgery may be necessary for oligodendrogliomas because these tumors sometimes redevelop.[encyclopedia.com]
  • Patients must take medications both before and after the surgery to prevent such complications. Seizures – Even for those patients who have never experienced seizures before, brain surgery patients may experience a few attacks after the operation.[brain-surgery.com]
  • If we did, then we would be able to treat them more effectively, or even prevent them occurring at all.[brainstrust.org.uk]
  • Supportive therapy to improve symptoms and neurologic function include corticosteroids to reduce swelling in the brain caused by the tumor and anticonvulsants to control or prevent seizures.[webmd.com]

References

Article

  1. Madhusoodanan S, Ting MB, Farah T, Ugur U. Psychiatric aspects of brain tumors: A review. World J Psychiatry. 2015;5(3):273-285.
  2. Filley CM, Kleinschmidt-DeMasters BK. Neurobehavioral presentations of brain neoplasms. West J Med. 1995;163:19–25.
  3. Arifin MZ, Yudoyono F, Setiawan C, Sidabutar R, Sutiono AB, Faried A. Comprehensive management of frontal and cerebellar tumor patients with personality changes and suicidal tendencies. Surg Neurol Int.. 2014;5:174.
  4. Kopp B, Rösser N, Tabeling S, et al. Performance on the Frontal Assessment Battery is sensitive to frontal lobe damage in stroke patients. BMC Neurol. 2013;13:179.
  5. Murphy P, Shallice T, Robinson G, et al. Impairments in proverb interpretation following focal frontal lobe lesions. Neuropsychologia. 2013;51:2075–2086.
  6. Yakhmi S, Sidhu BS, Kaur J, Kaur A. Diagnosis of frontal meningioma presenting with psychiatric symptoms. Indian J Psychiatry. 2015;57(1):91-93.
  7. Butler C, Zeman AZ. Neurological syndromes which can be mistaken for psychiatric conditions. J Neurol Neurosurg Psychiatry. 2005;76(Suppl 1):i31–8.
  8. Albon E, Tsourapas A, Frew E, et al. Structural neuroimaging in psychosis: a systematic review and economic evaluation. Health Technol Assess. 2008;12:iii–iv, ix-163

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Last updated: 2019-07-11 20:56