With approximately 12,500 deaths and 20,500 new cases every year in the United States, gliomas are the most common primary tumors of the brain [1] [2]. Although numerous risk factors of various origins have been proposed (such as viral infections by varicella zoster virus - VZV and cytomegalovirus - CMV, genetic predisposition, nonionizing radiation from cellular phones, etc.), occupational exposure to pesticides or organic solvents and ionizing radiation have the strongest association with the development of gliomas [1] [2] [3] [4]. These tumors are encountered in two age groups - In the first decade of life (0-8 years) and in late adulthood/the elderly (50-70 years of age) [1]. The clinical presentation can vary widely depending on the tumor location, but the two main symptoms are convulsions and a decrease in cognitive function [5]. In addition, memory and speech deficits, gait disturbances, headaches, nausea, vomiting, visual and/or auditory impairment, as well as personality changes are all mentioned in the literature as possible symptoms of gliomas [1] [6]. Furthermore, tumors originating from the brainstem produce an array of clinical signs, including cranial nerve palsies (predominantly of the V, VI, and VIII) and pyramidal weakness [4]. Progression of symptoms can be either slow or rapid, depending on the subtype. An early diagnosis is mandatory in either case, however, survival rates for gliomas diagnosed in the most advanced stages rarely exceed 1 year [6].

• Nausea

  Case reports: 1) An 18 year-old female patient was admitted due to headaches, nausea and vomiting and visual abnormalities. She was in amenorrhea. A brain magnetic resonance imaging (MRI) demonstrated a 35 mm-diameter sellar and suprasellar mass. [ncbi.nlm.nih.gov]

  General symptoms include headache, confusion, change in personality, nausea, loss of balance or coordination, memory loss, blurred vision or other visual abnormalities, and slurred speech. [britannica.com]

  Short term side effects of radiation therapy can include: Nausea Diarrhea Fatigue Skin changes Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. [texaschildrens.org]

  Symptoms include headaches, nausea, vomiting, dizziness and balance problems. Diagnosis is made with an MRI, but a confirming biopsy is usually required. Treatment may include surgery, radiation and/or chemotherapy. [ucihealth.org]

  Nausea and vomiting Some of the chemotherapy drugs used may make your child feel sick or vomit. We will give anti-sickness drugs at the same time to stop nausea and vomiting. These are usually very effective. [royalmarsden.nhs.uk]

• Dyslexia

  The CME unit “The Diagnosis and Treatment of Dyslexia” (issue 41/2010) can be accessed until 26 November 2010. For issue 49/2010 we plan to offer the topic “Idiopathic Scoliosis.” [ncbi.nlm.nih.gov]

• Primary Amenorrhea

  We describe an unusual case of a young girl who presented with clinical triad of obesity, primary amenorrhea and central cord syndrome. [ncbi.nlm.nih.gov]

• Headache

  Three years after surgery, the patient is lucid, with hypopituitarism under replacement. 2) A 46 year-old woman complained about a three year-history of amenorrhea, galactorrhea and headache. [ncbi.nlm.nih.gov]

  Headaches and seizures are the most common symptoms. Headaches usually occur in early morning, sometimes waking people up, and worsen with coughing or sneezing. The growing tumor pressing up against the skull causes the headaches. [spectrumhealth.org]

  Astroctyoma symptoms Headache Seizure Behavioural changes Ependymoma symptoms Increased head size Irritability Vomiting Inability to sleep Nausea Vomiting Headache Oligodendroglioma symptoms Headache Seizure Behavioral changes Weakness on one side of [news-medical.net]

• Upbeat Nystagmus

  Facial sensory loss and a primary-position, upbeating nystagmus may be seen. Crossed deficits (facial signs and symptoms contralateral to arm/leg signs and symptoms) are also characteristic of brainstem gliomas. [emedicine.medscape.com]

• Downbeat Nystagmus

  nystagmus and oculomyoclonus (medullary involvement) See Clinical Presentation for more detail. [emedicine.medscape.com]

Having in mind the very poor prognosis of late-stage gliomas, all patients with the undisclosed central nervous system (CNS)-related symptoms must be evaluated in a thorough manner. Firstly, the course of symptoms should be noted during history taking, whereas a meticulous physical examination, with an emphasis on the neurological exam and cognitive assessment, can provide vital clues about the location of the lesion. Imaging studies are the cornerstone of diagnosing gliomas. Magnetic resonance imaging (MRI), sometimes supported by magnetic resonance spectroscopy (MRS), is the modality of choice in identifying the exact site of the tumor and in determining the extent of tissue and nodal invasion [1] [4]. To confirm the diagnosis, however, a biopsy and a histopathological examination are necessary, which aids in classifying tumor into one of its three main categories [1] [2] [3] [5] [6]:

• Astrocytomas - Encompassing about 80% of all gliomas, astrocytomas are diagnosed either as low-grade tumors of limited proliferative capacities (stage I), or as highly malignant lesions (well-differentiated, anaplastic, and glioblastoma multiforme are terms used to describe stages II, III and IV, respectively) [1] [3] [6]. The two main forms are diffuse (malignant) and pilocytic (more often benign), and the distinguishing feature of astrocytomas on pathohistological examinations is the positive staining for glial fibrillary acidic protein (GFAP) on immunohistochemistry [1] [6].
• Oligodendrogliomas - Contrary to astrocytomas, oligodendrogliomas are principally benign tumors arising in the frontal lobes of the cerebral cortex. This tumor, based on its histological characteristics, is classified into stage II, but more severe anaplastic forms (stage III) carry a somewhat poorer prognosis, although the outcome is much better compared to astrocytomas [1] [6].
• Ependymomas - These tumors are very rarely encountered and comprise about 5-10% of all gliomas, developing in close proximity of the fourth ventricle in the majority of case.

• White Matter Lesions

  These cases emphasise the importance of careful discussion with patients before starting radiotherapy if there is a previous history of central nervous system demyelination or multiple white matter lesions on MRI. [ncbi.nlm.nih.gov]

1. Gladson CL, Prayson RA, Liu W (Michael). The Pathobiology of Glioma Tumors. Annual review of pathology. 2010;5:33-50.
2. Schwartzbaum JA, Fisher JL, Aldape KD, Wrensch M. Epidemiology and molecular pathology of glioma. Nat Clin Pract Neurol. 2006;2(9):494-503.
3. Ostrom QT, Bauchet L, Davis FG, et al. The epidemiology of glioma in adults: a “state of the science” review. Neuro-Oncology. 2014;16(7):896-913.
4. Reyes-Botero G, Mokhtari K, Martin-Duverneuil N, Delattre J-Y, Laigle-Donadey F. Adult Brainstem Gliomas. Oncologist. 2012;17(3):388-397.
5. Posti JP, Bori M, Kauko T, et al. Presenting symptoms of glioma in adults. Acta Neurol Scand. 2015 Feb;131(2):88-93.
6. Aster, JC, Abbas, AK, Robbins, SL, Kumar, V. Robbins basic pathology. Ninth edition. Philadelphia, PA: Elsevier Saunders; 2013.