Presentation

Brain tumours present either with neurological dysfunction or with signs of raised intracranial pressure. Presentation with epilepsy or with slow onset of symptoms carries a relatively favourable prognosis.

Table 25.2 Abbreviated WHO (1993) classification of intracranial gliomas

Subgroup

Grade or type

Prognosis

Astrocytoma

Pilocytic

Excellent

Low-grade

Good

Anaplastic

Poor

Glioblastoma

Very poor

Oligodendroglioma

Low-grade

Good

Anaplastic

Poor

Ependymoma

Low-grade

Good

Anaplastic

Poor

Table 25.3 Presenting symptom in patients with intracranial glioma

Symptom

Frequency as principle presenting symptom (%)

Overall frequency at presentation (%)

Epilepsy

30

53

Headache

25

71

Cognitive distance

12

52

Motor disturbance

8

43

Speech disturbance

5

27

Clouding of consciousness

4

25

Visual disturbance

4

25

Sensory change

2

14

Miscellaneous

10

Investigation is dominated by brain imaging. Maximal tumour resolution in structural imaging involves full-sequence magnetic resonance scanning with gadolinium enhancement. Contrast-enhanced CT is more readily available and frequently adequate. Functional imaging with SPEC, PET, and MR are gaining importance both in diagnosis and assessment of response to treatment. The imaging agents 201thallium and 123I-tyrosine in SPECT scanning and 18FDG glucose in PET give important insights into the functional activity of the tumour and can frequently aid differentiation between high- or low-grade neoplasms and treatment-induced necrosis. Tumours that spread via CSF pathways require whole neuraxis MRI.

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