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Pilocytic Astrocytoma


Presentation

  • The pilocytic (astrocytoma) variant of ONG almost always presents during the first two decades of life. In this report, the authors discuss an unusual presentation of pilocytic astrocytoma of the juvenile type in an elderly Indian male.[ncbi.nlm.nih.gov]
Weakness
  • We present the case of a 2-year-old boy with progressive left-sided weakness and a cranial magnetic resonance imaging (MRI) scan showing a lesion with a cystic component in the right thalamus and basal ganglia.[ncbi.nlm.nih.gov]
  • […] the skin; burning, itching, swelling, hardening, and tightening of the skin; yellow spots on the whites of the eyes; joint stiffness with trouble moving or straightening the arms, hands, legs, or feet; pain deep in the hip bones or ribs; and muscle weakness[emedicine.com]
  • Symptoms General symptoms include: Headaches Weakness on one side of the body Problems with balance Seizures Behavior, memory and personality changes Pilocytic Astrocytoma Treatment Because pilocytic astrocytoma tumors do not spread to surrouding cells[uwhealth.org]
  • For example, a tumor in the cerebellum may cause weakness, problems walking, and clumsiness, and optic nerve gliomas may cause visual loss and a protrusion of the eyes.[neurosurgeonsofnewjersey.com]
Developmental Delay
  • Together these data support a role for NTM and OPCML in developmental delay and potentially in cancer susceptibility.[ncbi.nlm.nih.gov]
Vomiting
  • Herein, we report a seventeen-year-old boy with a history of ventriculo-peritoneal shunt insertion due to severe hydrocephalus who presented with progressive headache and vomiting together with ocular and cerebellar signs and symptoms.[ncbi.nlm.nih.gov]
Nausea
  • An 18-year-old girl presented with a history of visual disturbance without headache, nausea, or vomiting in May 2010. In July 2010, the patient visited our hospital because of visual disturbance.[ncbi.nlm.nih.gov]
  • Changes in personality or mental status Difficulty balancing Drowsiness Headaches Nausea Problems with vision Seizures Vomiting Pediatric Pilocytic Astrocytoma Doctors and Providers[childrens.com]
Hepatosplenomegaly
  • One patient had hepatosplenomegaly and impaired glucose tolerance, and another patient had severe hyperglycemia and hypertriglyceridemia during the course of the disease.[ncbi.nlm.nih.gov]
Advanced Bone Age
  • Two patients presented with central precocious puberty and advanced bone age at the chronological age of 6 years.[ncbi.nlm.nih.gov]
Headache
  • We report a case of a 47-year-old man presenting with sudden-onset frontal headache associated with nausea and lethargy in addition to a background of a longer history of back pain and headache.[ncbi.nlm.nih.gov]
Seizure
  • The patient has since remained seizure-free for 2.5 years. Seizure outcomes at postoperative 1-2 years are highly predictive of long-term outcomes after TLR for temporal lobe epilepsy (TLE).[ncbi.nlm.nih.gov]
Irritability
  • Besides previously postulated hypotheses of viral-induced or angiogenic factor-induced glial growth, we hypothesize that neoplastic origins of hypothalamic-optochiasmatic glioma might be due to the irritative mechanisms resulting from the frequent bleeds[ncbi.nlm.nih.gov]
  • Children affected by pilocytic astrocytoma can present with different symptoms that might include failure to thrive (lack of appropriate weight gain/ weight loss), headache, nausea, vomiting, irritability, torticollis (tilt neck or wry neck), difficulty[en.wikipedia.org]
  • This type of tumor can often be cured with surgery. [1] [2] [3] Last updated: 8/9/2013 People with pilocytic astrocytomas might experience symptoms including: headaches, nausea, vomiting, irritability, ataxia (uncoordinated movement or unsteady gait),[rarediseases.info.nih.gov]
  • A JPA in the hypothalamic region may be associated with weight gain or loss, premature puberty or diencephalic syndrome, which is characterized by failure to thrive, abnormal thinness, irritability, and eye abnormalities.[rarediseases.org]
  • The baby developed irritability and fussiness with marked proptosis of the left globe following surgery. The radiotherapy was felt to yield relief to the symptoms.[nature.com]
Lethargy
  • We report a case of a 47-year-old man presenting with sudden-onset frontal headache associated with nausea and lethargy in addition to a background of a longer history of back pain and headache.[ncbi.nlm.nih.gov]
  • Common findings (often caused by pressure within the brain from a large tumor or blockage of the flow of cerebrospinal fluid include, lethargy, headaches, drowsiness, clumsiness, vomiting particularly in the morning, and changes in personality or mental[nicklauschildrens.org]
  • […] different portions of the brain, it can have varied neurological disturbances such as: Hydrocephalus – due to the abnormal accumulation of cerebrospinal fluid found in the brain Increased intracranial pressure associated problems including: Headache Lethargy[cancerwall.com]
  • Symptoms commonly associated with increased pressure on the brain include headaches, lethargy or drowsiness, vomiting, and changes in personality or mental status.[rarediseases.org]
  • Such children may have little in the way of other neurologic findings, but can have macrocephaly, intermittent lethargy, and visual impairment.[ 3 ] Diagnostic Evaluation The diagnostic evaluation for astrocytoma is often limited to a magnetic resonance[cancer.gov]
Nystagmus
  • We report the case of a 6-month-old female child with IP who presented with unilateral nystagmus and was found to have a pilocytic astrocytoma with leptomeningeal spread.[ncbi.nlm.nih.gov]
  • […] different symptoms that might include failure to thrive (lack of appropriate weight gain/ weight loss), headache, nausea, vomiting, irritability, torticollis (tilt neck or wry neck), difficulty to coordinate movements, and visual complaints (including nystagmus[en.wikipedia.org]
  • A JPA in the optic nerve pathways may be associated with loss of vision, degeneration (atrophy) of the optic nerve, papilledema, nystagmus, and protrusion of the eyeball (proptosis).[rarediseases.org]
  • Blockage in the brainstem causing: Nausea Vomitting Ataxia – the inability to coordinate movements Torticollis – Wryneck Problems with balance and coordination Blockage in the optic nerve pathways resulting to: Papilledema – inflammation of the optic disc Nystagmus[cancerwall.com]
  • A tumor pressing on the optic nerve may cause vision changes, such as blurry vision or involuntary rapid eye movements, or nystagmus.[healthline.com]

Workup

  • Recognition of this variant may prevent an unnecessary workup to exclude other etiologies such as parasitic infection (ie, cysticercosis) or cystic metastatic disease.[ncbi.nlm.nih.gov]
  • Roonprapunt and Abbot have suggested a treatment algorithm for the initial surgical workup of brain stem gliomas. [31] Figure 3: A seemingly diffuse infiltrative non-enhancing mid brain lesion on the CT scan is seen as a focal lesion on MRI scan Click[pediatricneurosciences.com]

Treatment

  • One patient died of an intracerebral hemorrhage 10 years following initial radiation treatment believed to be secondary to radiation vasculopathy.[ncbi.nlm.nih.gov]
  • Steroid treatment is often used to control tissue swelling that may occur pre- and post-operatively. Children can also suffer long term side effects due to the type of treatment they may receive.[en.wikipedia.org]

Prognosis

  • Therefore, the prognosis is largely unpredictable and there is controversy regarding the management of patients for whom complete resection cannot be achieved.[ncbi.nlm.nih.gov]

Etiology

  • Recognition of this variant may prevent an unnecessary workup to exclude other etiologies such as parasitic infection (ie, cysticercosis) or cystic metastatic disease.[ncbi.nlm.nih.gov]

Epidemiology

  • Our model analysis shows that the tumor behavior after partial resection is essentially determined by a risk coefficient γ, which can be deduced from epidemiological data about PA.[ncbi.nlm.nih.gov]
  • African American, Latin American, and Asian individuals are less likely to develop pilocytic astrocytoma. [7] References 1.0 1.1 1.2 1.3 1.4 1.5 1.6 Epidemiology of pilocytic astrocytoma. Dr Bruno Di Muzio and Dr Frank Gaillard et al.[wikidoc.org]
  • The remaining eight chapters have a common format, reviewing the history, epidemiology, biology, pathology, clinical symptoms, differential diagnosis, treatment, prognosis, and complications of specific tumors.[books.google.com]
  • Epidemiology Pilocytic astrocytoma typically occurs in the first two decades of life. See Pilocytic Astrocytoma in adults. Localization Pilocytic astrocytoma may occur throughout the neuraxis.[prod.wiki.cns.org]
  • Definition / general Pilocytic means "hair-like," due to long, bipolar processes Most common CNS neoplasm of childhood Better prognosis than diffuse types, particularly if resectable (such as cerebellar tumors) WHO grade I Epidemiology Most common CNS[pathologyoutlines.com]
Sex distribution
Age distribution

Pathophysiology

  • Pathophysiology Pilocytic astrocytomas (ie, WHO grade I) arise throughout the neuraxis, but preferred sites include the optic nerve, optic chiasm/hypothalamus, thalamus and basal ganglia, cerebral hemispheres, cerebellum, and brain stem.[emedicine.medscape.com]

Prevention

  • Recognition of this variant may prevent an unnecessary workup to exclude other etiologies such as parasitic infection (ie, cysticercosis) or cystic metastatic disease.[ncbi.nlm.nih.gov]
  • But there is no way to prevent them, and there’s nothing you can do to reduce a child’s risk of developing one.[weillcornellbrainandspine.org]
  • If they saw clear-cut evidence of tumor growth, they would need to intervene to prevent potentially debilitating symptoms. Brain surgery in the future remained a distinct possibility for Travis.[upmc.com]

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