Last reviewed: 7 Jan 2023
Last updated: 25 Jan 2023



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
  • papilledema
  • personality change/emotional lability
Other diagnostic factors

Risk factors

  • white ancestry
  • male sex
  • neurofibromatosis type 1
  • tuberous sclerosis complex
  • Li-Fraumeni syndrome
  • Turcot syndrome
  • ionizing radiation
More risk factors

Diagnostic investigations

1st investigations to order

  • MRI head
  • ophthalmologic evaluation; visual field testing
  • CT head
  • brain MR spectroscopy
  • brain perfusion MRI
  • histopathology
  • molecular analyses
More 1st investigations to order

Investigations to consider

  • pituitary hormones tests
  • diffusion tensor imaging (DTI)
More investigations to consider

Emerging tests

  • 2-hydroxyglutarate-targeted magnetic resonance spectroscopy

Treatment algorithm


elevated intracranial pressure or vasogenic edema


circumscribed glioma: pilocytic/pilomyxoid astrocytoma

circumscribed glioma: subependymal giant cell astrocytoma (SEGA)

circumscribed glioma: pleomorphic xanthoastrocytoma

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



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




LNGC has received research funding from the National Institutes of Health, the Robert Wood Johnson Foundation, the American Society of Clinical Oncology, and Merck & Co. (to Dana-Farber Cancer Institute), and acted as consultant for Teladoc, Elsevier PracticeUpdate, and Oakstone Publishing. LNGC is an author of a number of references cited in this topic.


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.


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.

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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