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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].

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]
  • […] compression of the sixth cranial nerve at the base of the brain Impaired upward gaze, called Parinaud syndrome, may occur with pineal tumors Tumors of the occipital lobe specifically may produce homonymous hemianopia or partial visual field deficits Anosmia[emedicine.medscape.com]
  • Location - Olfactory Groove and sella (bony space where the pituitary gland is situated) Common Symptoms - Loss of smell (anosmia), subtle personality changes, mild difficulty with memory, euphoria, diminished concentration, urinary incontinence, visual[neurosurgery.ucla.edu]
Fatigue
  • How can I cope with fatigue? Patients with benign and malignant brain tumors and long-term survivors often experience fatigue.[lahey.org]
  • 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]
  • These types of radiation may cause side effects including fatigue and skin irritation.[yalemedicine.org]
  • Although chemotherapy has many short-term side effects (such as fatigue, nausea, vomiting, and hair loss), it has fewer long-term side effects than radiation therapy.[kidshealth.org]
  • 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]
Intermittent Claudication
  • claudication intestine intracranial joint joint prosthesis kidney knee laceration lacrimal lower limb lung malignant molar pregnancy multiple muscle Neoplasm nerve newborn nondisplaced nontraumatic obstetrical trauma obstruction organ Osteochondrosis[books.google.de]
Urinary Incontinence
  • Location - Olfactory Groove and sella (bony space where the pituitary gland is situated) Common Symptoms - Loss of smell (anosmia), subtle personality changes, mild difficulty with memory, euphoria, diminished concentration, urinary incontinence, visual[neurosurgery.ucla.edu]
  • Children with metastatic tumors (some primitive neuroectodermal or germ cell tumors) often present with metastases to the spinal cord and cauda equina, and may have back pain, urinary incontinence, or focal extremity weakness or sensory loss.[hawaii.edu]
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]
  • Postoperative Considerations The risk of post-operative seizures is significant [15]. Oligodendrogliomas [29], extraaxial lesions such as meningiomas [21] as well as slow growing lesions [13] carry a higher risk of post-operative seizure activity.[openanesthesia.org]
  • ., without symptoms), but some may cause impaired speech and seizures.[healthcommunities.com]
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]
  • [ 1 , 2, 3 ] In patients with established headache, may manifest as a change in the headache pattern New onset of headaches in middle-aged or older patients is worrisome The location of the headache reliably indicates the side of the head affected, but[emedicine.medscape.com]
  • Photo Credit: 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[livestrong.com]
  • Nausea, vomiting, and headaches are common symptoms. Brain tumors can damage vital neurological pathways and invade and compress brain tissue. Symptoms usually develop over time and their characteristics depend on the location and size of the tumor.[healthcommunities.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]
Confusion
  • […] of the legs at night associated with transient confusion and headache the next morning.[austinpublishinggroup.com]
  • Back on Her Feet Thanks to CSF Leak Repair A cerebrospinal fluid leak caused Beth Johnson’s brain to shift and sag away from her skull when she tried to stand, leading to severe headaches and periods of confusion.[braintumortreatment.com]
  • […] adults) weakness of a limb or part of the face a change in mental functioning Other common symptoms include: clumsiness memory loss confusion difficulty writing or reading changes in the ability to hear, taste, or smell decreased alertness, which may[healthline.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]
  • A man is standing by his confused wife. Photo Credit: 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]
Personality Change
  • Location - Sphenoid Ridge Common Symptoms - Eye-bulging, decreased vision, paralysis of eye movement, seizures, memory difficulty, personality change, headache.[neurosurgery.ucla.edu]
  • Symptoms may include headaches, personality changes (such as suddenly becoming depressed, anxious, or uninhibited), loss of balance, trouble concentrating, seizures, and incoordination.[merckmanuals.com]
  • 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]
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]
  • Findings may include the following: Papilledema, which is more prevalent with pediatric brain tumors, reflects an increase in intracranial pressure (ICP) of several days or longer Diplopia may result from displacement or compression of the sixth cranial[emedicine.medscape.com]
  • […] cause the following: Behavioral and emotional changes Impaired judgment Impaired sense of smell Memory loss Paralysis on one side of the body (hemiplegia) Reduced mental capacity (cognitive function) Vision loss and inflammation of the optic nerve (papilledema[healthcommunities.com]
  • […] field testing (see the section on papilledema in Chapter 1 ).[dartmouth.edu]
  • .), reduction in visual acuity and visual fields and papilledema. Continue with the MR images. Notice the normal inferiorly displaced pituitary gland. This means it is not a macroadenoma. The diagnosis is again a craniopharyngioma.[radiologyassistant.nl]

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

  • Clinical Programs & Services Medical and surgical care for brain tumors with a patient-focused approach Advanced treatment for strokes, aneurysms and related conditions Nonsurgical and surgical treatment for a wide variety of spinal issues Specialized[braintumortreatment.com]
  • 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]
  • It may be used both for diagnosis and treatment. Chemotherapy: This treatment uses drugs to stop the growth of cancer cells, either by killing them or stopping them from dividing.[cedars-sinai.edu]
  • 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]
  • Treatment is dictated by the tumor's location and patient's symptoms.[aans.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]
  • In this article arrow-down Aetiology arrow-down Epidemiology arrow-down Presentation arrow-down Differential diagnosis arrow-down Investigations arrow-down Management arrow-down Complications arrow-down Prognosis Frontal lobe syndrome (FLS) reflects damage[patient.info]
  • 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]
  • Anaplastic astrocytoma: diagnosis, prognosis, and management. Semin Oncol. 2004;31:618-34. Jennings MT, Ivengar S. Pharmacotherapy of malignant astrocytomas of children and adults: current strategies and future trends. CNS Drugs. 2001;15:719-43.[rarediseases.org]

Etiology

  • It is likely that while the etiology of PCNSL in the non-immunosuppressed remains obscure, in immunosuppressed individuals with reduced immune surveillance (under T cell control) the Epstein Barr virus (EBV) may be directly implicated.[thamburaj.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]
  • 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]

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]
  • The much publicised suggested risks of mobile phone use and habitat in proximity to ‘power lines’ have neither of them been shown (in well conducted epidemiological studies) to be related to an increased incidence of brain tumours.[canceradvice.co.uk]
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]
  • When symptoms do occur, it is because the brain tumour is either putting pressure on the brain or preventing an area of the brain from functioning properly.[your.md]
  • 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]

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: 2018-06-22 02:13