Tumours Of The Cerebral Hemispheres Intrinsic

ASTROCYTOMA (contd) CLINICAL FEATURES

Astrocytomas may present with:

- epilepsy - more common with low grade tumours

- signs and symptoms of focal brain damage - dysphasia, hemiparesis, personality change

- signs and symptoms of raised intracranial pressure - headache, vomiting, depression of conscious level.

Symptoms usually develop gradually, progressing over several weeks, months or years, the rate depending on the degree of malignancy. Sudden deterioration suggests haemorrhage into a necrotic area. In a patient with long standing epilepsy, the rapid development of further symptoms may result from malignant change within a previously 'low grade' lesion.

INVESTIGATIONS

Skull X-ray. of limited value; shift of a calcified pineal or erosion of the dorsum sella indicates the presence of an intracranial mass.

CT scan: appearances vary considerably; in general, malignant and low grade lesions show different characteristics:

Malignant astrocytoma/glioblastoma multiforme

The lesion, site and associated mass effect

- ventricular compression

- midline shift are clearly demonstrated

Areas of mixed density, irregularly enhance with contrast. No plane exists between tumour and brain indicating infiltration

Surrounding regions of low density indicate either oedema or infiltrative tumour

Central, low density regions represent necrotic areas or cystic cavities; neither enhances with contrast

Low grade astrocytoma

A low dei n, usually unenhancing with contrast suggests a low grade infiltrative lesion; detection is often difficult in early stages.

A low dei n, usually unenhancing with contrast suggests a low grade infiltrative lesion; detection is often difficult in early stages.

Calcification occasionally occurs.

Calcification occasionally occurs.

MRI may detect low grade infiltrative tumours before these become evident on CT scan.

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