Summary
Definição
História e exame físico
Principais fatores diagnósticos
- presence of risk factors
Outros fatores diagnósticos
- altered mental status
- headache
- nausea and/or vomiting
- gait abnormality
- ataxia
- weakness
- seizures
- visual disturbances
- speech deficit
- aphasia/dysphasia
- sensory deficit
- motor weakness
- visual change
- cranial nerve palsy
- papilloedema
- personality change/emotional lability
Fatores de risco
- white ancestry
- male sex
- neurofibromatosis type 1
- tuberous sclerosis complex
- Li-Fraumeni syndrome
- Turcot's cancer syndrome
- ionising radiation
Investigações diagnósticas
Primeiras investigações a serem solicitadas
- MRI head
- ophthalmological evaluation; visual field testing
- CT head
- brain MR spectroscopy
- brain perfusion MRI
- histopathology
- molecular analyses
Investigações a serem consideradas
- pituitary hormones tests
- diffusion tensor imaging (DTI)
Novos exames
- 2-hydroxyglutarate-targeted magnetic resonance spectroscopy
Algoritmo de tratamento
elevated intracranial pressure or vasogenic oedema
circumscribed glioma: pilocytic/pilomyxoid astrocytoma (World Health Organization [WHO] grade 1)
circumscribed glioma: subependymal giant cell astrocytoma (WHO grade 1)
circumscribed glioma: pleomorphic xanthoastrocytoma (WHO grade 2)
diffuse infiltrating glioma: grade 2
diffuse infiltrating glioma: grades 3 and 4
diffuse midline glioma, H3 K27M-altered
recurrent circumscribed glioma
progressive diffuse infiltrating glioma
Colaboradores
Autores
L. Nicolas Gonzalez Castro, MD, PhD
Instructor in Neurology
Center for Neuro-Oncology
Dana-Farber Cancer Institute and Brigham and Women's Hospital
Harvard Medical School
Boston
MA
Declarações
LNGC has received consulting fees from Elsevier, Oakstone Publishing, and Teladoc. LNGC has received research funding from Merck & Co. (to Dana-Farber Cancer Institute). LNGC is an author of a number of references cited in this topic.
Agradecimentos
Dr L. Nicolas Gonzalez Castro would like to gratefully acknowledge Dr Timothy C. Ryken, Dr Linton T. Evans, Dr Manmeet S. Ahluwalia, Dr Susan Chang, and Dr Karine Michaud, previous contributors to this topic.
Declarações
TCR is an author of a number of references cited in this topic. MSA has acted as a consultant for Elekta, Incyte, AstraZeneca, Novocure, Caris Life Sciences, Bristol-Myers Squibb, Monteris Medical, AbbVie, MRI Solutions, Elsevier, and Prime oncology. MSA has received clinical trial investigations grants from Tracon, Bristol-Myers Squibb, AstraZeneca, Novartis, and Novocure. SC has received research support from Agios, Novartis, Quest, Roche, and Schering Plough. KM and LTE declare that they have no competing interests.
Revisores
David A. Reardon, MD
Associate Professor
The Preston Robert Tisch Brain Tumor Center
Duke University Medical Center
Durham
NC
Declarações
DAR declares that he has no competing interests.
Créditos aos pareceristas
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Declarações
As afiliações e declarações dos pareceristas referem--se ao momento da revisão.
Referências
Principais artigos
Louis DN, Perry A, Wesseling P, et al. The 2021 WHO classification of tumors of the central nervous system: a summary. Neuro Oncol. 2021 Aug 2;23(8):1231-51.Texto completo Resumo
National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology: central nervous system cancers [internet publication].Texto completo
Weller M, van den Bent M, Preusser M, et al. EANO guidelines on the diagnosis and treatment of diffuse gliomas of adulthood. Nat Rev Clin Oncol. 2021 Mar;18(3):170-86.Texto completo Resumo
Liau LM. Guidelines for newly diagnosed glioblastoma. J Neurooncol. 2008 Sept;89(3).Texto completo
American Association of Neurological Surgeons; Congress of Neurological Surgeons. Updated AANS/CNS guidelines for progressive glioblastoma patients. Jun 2022 [internet publication].Texto completo
Artigos de referência
Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.
Diagnósticos diferenciais
- Brain metastasis
- Brain abscess
- Multiple sclerosis
Mais Diagnósticos diferenciaisDiretrizes
- NCCN clinical practice guidelines in oncology: central nervous system cancers
- Therapy for diffuse astrocytic and oligodendroglial tumors in adults: ASCO-SNO guideline
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