Astrocytic brain tumors

Last reviewed: 1 Sep 2022
Last updated: 15 Oct 2019

Summary

Definition

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

Risk factors

  • white ancestry
  • male sex
  • neurofibromatosis type 1
  • tuberous sclerosis
  • 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
  • spectroscopy MRI head
  • perfusion MRI head
  • biopsy
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

INITIAL

elevated intracranial pressure or vasogenic edema

ACUTE

grade I: pilocytic astrocytoma

grade I: subependymal giant cell astrocytoma

grade II (excluding diffuse pontine glioma): pleomorphic xanthoastrocytoma

grade II (excluding diffuse pontine glioma): pilomyxoid astrocytoma

grade II (excluding diffuse pontine glioma): diffuse astrocytoma

grade III (excluding diffuse pontine glioma)

grade IV (excluding diffuse pontine glioma)

diffuse pontine glioma

ONGOING

grade I: recurrent pilocytic astrocytoma

grade I: recurrent subependymal giant cell astrocytoma

grade II (excluding diffuse pontine glioma): recurrent pleomorphic xanthoastrocytoma

grade II (excluding diffuse pontine glioma): recurrent pilomyxoid astrocytoma

grade II (excluding diffuse pontine glioma): recurrent diffuse astrocytomas

recurrent grade III (excluding diffuse pontine glioma)

recurrent grade IV (excluding diffuse pontine glioma)

recurrent diffuse pontine glioma

Contributors

Authors

Timothy C. Ryken, MD, MS

Chief of Neurosurgery

Dartmouth-Hitchcock Medical Center

Lebanon

NH

Disclosures

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

Lebanon

NH

Disclosures

LTE declares that he has no competing interests.

Acknowledgements

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.

Disclosures

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

Durham

NC

Disclosures

DAR declares that he has no competing interests.

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