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
Risk factors
- white ancestry
- male sex
- neurofibromatosis type 1
- tuberous sclerosis
- Li-Fraumeni syndrome
- Turcot syndrome
- ionizing radiation
Diagnostic investigations
1st investigations to order
- MRI head
- ophthalmologic 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
elevated intracranial pressure or vasogenic edema
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
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.
Differentials
- Brain metastasis
- Brain abscess
- Multiple sclerosis
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