Last reviewed: 8 Nov 2021
Last updated: 15 Oct 2019



History and exam

Other diagnostic factors

  • 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
  • cognitive decline
  • nystagmus
  • ipsilateral dysmetria
  • acalculia
  • finger agnosia
  • left-right confusion
  • alexia (without agraphia)
  • neglect
  • hypothalamic syndrome

Risk factors

  • white ancestry
  • male sex
  • neurofibromatosis type 1
  • tuberous sclerosis
  • Li-Fraumeni syndrome
  • Turcot's cancer syndrome
  • ionising radiation

Diagnostic investigations

1st investigations to order

  • MRI head
  • ophthalmological evaluation; visual field testing
  • CT head
  • spectroscopy MRI head
  • perfusion MRI head
  • biopsy

Investigations to consider

  • pituitary hormones tests
  • diffusion tensor imaging (DTI)

Emerging tests

  • 2-hydroxyglutarate-targeted magnetic resonance spectroscopy

Treatment algorithm



Timothy C. Ryken, MD, MS

Chief of Neurosurgery

Dartmouth-Hitchcock Medical Center




TCR is an author of a number of references cited in this topic.

Linton T. Evans, MD

Assistant Professor of Neurosurgery

Dartmouth-Hitchcock Medical Center




LTE declares that he has no competing interests.


Dr Timothy C. Ryken and Dr Linton T. Evans would like to gratefully acknowledge Dr Manmeet S. Ahluwalia, Dr Susan Chang, and Dr Karine Michaud, previous contributors to 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 declares that she has no competing interests.

Peer reviewers

David A. Reardon, MD

Associate Professor

The Preston Robert Tisch Brain Tumor Center

Duke University Medical Center




DAR declares that he has no competing interests.

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