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Cuneo A, Murinova N. Headache Management in Individuals with Brain Tumor. Semin Neurol 2024; 44:74-89. [PMID: 38183973 DOI: 10.1055/s-0043-1777423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2024]
Abstract
Headache occurs commonly in individuals diagnosed with cerebral neoplasm. Though the features of a brain tumor-associated headache may vary, a progressive nature of headache and a change in headache phenotype from a prior primary headache disorder often are identified. Pathophysiologic mechanisms proposed for headache associated with brain tumor include headache related to traction on pain-sensitive structures, activation of central and peripheral pain processes, and complications from surgical, chemotherapeutic and/or radiotherapy treatment(s). Optimization of headache management is important for an individual's quality of life. Treatments are based upon patient-specific goals of care and may include tumor-targeted medical and surgical interventions, as well as a multimodal headache treatment approach incorporating acute and preventive medications, nutraceuticals, neuromodulation devices, behavioral interventions, anesthetic nerve blocks, and lifestyles changes.
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Affiliation(s)
- Ami Cuneo
- Department of Neurology, University of Washington, Seattle, Washington
| | - Natalia Murinova
- Department of Neurology, University of Washington, Seattle, Washington
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Millward CP, Keshwara S, Islim AI, Zakaria R, Jenkinson MD. Clinical Presentation and Prognosis. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2023; 1416:5-20. [PMID: 37432616 DOI: 10.1007/978-3-031-29750-2_2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 07/12/2023]
Abstract
Over the past three decades, the care for patients with meningioma has steadily improved as a result of a better understanding of the natural history, molecular biology, and classification of these tumors. Surgical frameworks for management have been established and validated with more options for adjuvant and salvage treatment available for patients with residual or recurrent disease. Overall these advances have improved clinical outcomes and prognosis.Alongside the improved clinical management has come an increase in biological understanding of these tumors. The number of publications within the field of meningioma research continues to expand and biological studies identifying molecular factors at the cytogenic and genomic level offer exciting potential for more personalized management strategies. As survival and understanding have increased, treatment outcomes are moving from traditional metrics, which describe the morbidity and mortality to more patient-centered measures. The subjective experiences of patients with meningioma are gaining interest among clinical researchers and it is recognized that even supposedly mild symptoms arising from meningioma can have a significant effect on a patient's quality of life.This chapter reviews the varied clinical presentations of meningioma, which in the modern era of widespread brain imaging must include a discussion of incidental meningioma. The second part examines prognosis and the clinical, pathological, and molecular factors that can be used to predict outcomes.
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Affiliation(s)
- Christopher P Millward
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Sumirat Keshwara
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Abdurrahman I Islim
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Rasheed Zakaria
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Michael D Jenkinson
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK.
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK.
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Thakkar JP, Prabhu VC, Rouse S, Lukas RV. Acute Neurological Complications of Brain Tumors and Immune Therapies, a Guideline for the Neuro-hospitalist. Curr Neurol Neurosci Rep 2020; 20:32. [PMID: 32596758 DOI: 10.1007/s11910-020-01056-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
PURPOSE OF REVIEW Patients with brain tumors presenting to the emergency room with acute neurologic complications may warrant urgent investigations and emergent management. As the neuro-hospitalist will likely encounter this complex patient population, an understanding of the acute neurologic issues will have value. RECENT FINDINGS We discuss updated information and management regarding various acute neurologic complications among neuro-oncology patients and neurologic complications of immunotherapy. Understanding of the acute neurologic complications associated with central nervous system tumors and with common contemporary cancer treatments will facilitate the neuro-hospitalist management of these patient populations. While there are aspects analogous to the diagnosis and management in the non-oncologic population, a number of unique features discussed in this review should be considered.
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Affiliation(s)
- Jigisha P Thakkar
- Department of Neurology, Stritch School of Medicine, Loyola University Medical Center, 2160 S. 1st Avenue, Bldg 105, Room 2700, Maywood, IL, 60153, USA. .,Department of Neurosurgery, Stritch School of Medicine, Loyola University Chicago, 2160 S. 1st Avenue, Bldg 105, Room 1900, Maywood, IL, 60153, USA.
| | - Vikram C Prabhu
- Department of Neurosurgery, Stritch School of Medicine, Loyola University Chicago, 2160 S. 1st Avenue, Bldg 105, Room 1900, Maywood, IL, 60153, USA
| | - Stasia Rouse
- Department of Neurology, Stritch School of Medicine, Loyola University Medical Center, 2160 S. 1st Avenue, Bldg 105, Room 2700, Maywood, IL, 60153, USA
| | - Rimas V Lukas
- Department of Neurology, Northwestern University Feinberg School of Medicine, 710 N. Lake Shore Drive, Abbott Hall 1114, Chicago, IL, 60611, USA.,Lou and Jean Malnati Brain Tumor Institute of the Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, 60611, USA
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Crum OM, Kilgore KP, Sharma R, Lee MS, Spiegel MR, McClelland CM, Bhatti MT, Chen JJ. Etiology of Papilledema in Patients in the Eye Clinic Setting. JAMA Netw Open 2020; 3:e206625. [PMID: 32484553 PMCID: PMC7267843 DOI: 10.1001/jamanetworkopen.2020.6625] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
IMPORTANCE The study of health conditions associated with papilledema will augment the clinical judgment of eye care professionals treating patients with optic disc edema in determining the urgency of additional evaluation and counseling patients accordingly. OBJECTIVES To determine the incidence, demographic characteristics, and etiologies of papilledema based on a unique records-linkage research platform; and to describe the demographic and clinical differences between patients with idiopathic intracranial hypertension (IIH) and other causes of papilledema. DESIGN, SETTING, AND PARTICIPANTS Retrospective population-based cross-sectional study of patients treated for papilledema at outpatient eye clinics in Olmsted County, Minnesota, using the Rochester Epidemiology Project. Data were collected from January 1990 to December 2014 and analyzed from September 2018 to April 2019. MAIN OUTCOMES AND MEASURES Etiologies of papilledema, body mass index, incidence of headache, or localizing neurologic signs. RESULTS Eighty-six patients were diagnosed with papilledema during the 24-year period, providing an age- and sex-adjusted incidence of 2.5 individuals per 100 000 per year; 68 patients (79%) were women, 73 (85%) were white patients, and the median (range) age was 27.7 (6.2-64.2) years. Nineteen patients (22%) presented with a previously diagnosed attributable cause (eg, trauma or intracranial tumor). Among patients presenting with papilledema without a previously diagnosed attributable cause, 58 patients (87%) had IIH, and 9 patients (13%) were found to have a secondary cause of raised intracranial pressure, such as intracranial tumor, cerebral venous sinus thrombosis, or granulomatous meningitis. Patients with IIH had a higher median (range) body mass index (37.5 [20.4-55.7] vs 27.4 [16.6-40.1]; P = .003) and headache prevalence (54 of 58 patients [93%] vs 6 of 9 patients [67%]; P = .004) than patients with other causes of papilledema. Of 9 patients with papilledema but no IIH, 2 (22%) had localizing neurologic signs, such as gait abnormalities, hearing loss, focal weakness or numbness, visual field defects, or aphasia. Among 42 patients with demographic characteristics typically associated with IIH (female sex, with obesity, aged 15 to 45 years, and absent localizing neurologic signs or symptoms), 40 (95%) had papilledema that was associated with IIH. Conversely, among the 19 patients without these demographic characteristics, 7 (37%) had an alternative cause. CONCLUSIONS AND RELEVANCE In this study, most patients who presented to the eye clinic with papilledema without a previously known cause were found to have IIH. These patients were more likely to present with headaches and had statistically higher body mass index. Clinicians should take these findings into account when determining the pretest probability of a patient having IIH or an alternative cause of papilledema.
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Affiliation(s)
- Olivia M. Crum
- Alix School of Medicine, Mayo Clinic, Rochester, Minnesota
| | - Khin P. Kilgore
- Department of Ophthalmology, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Rishi Sharma
- University of Minnesota College of Biological Sciences, Minneapolis
| | - Michael S. Lee
- Department of Ophthalmology and Visual Neurosciences, University of Minnesota, Minneapolis
| | - Matthew R. Spiegel
- Department of Health Sciences Research, Mayo Clinic, Jacksonville, Floriada
| | - Collin M. McClelland
- Department of Ophthalmology and Visual Neurosciences, University of Minnesota, Minneapolis
| | - M. Tariq Bhatti
- Department of Ophthalmology, Mayo Clinic College of Medicine, Rochester, Minnesota
- Department of Neurology, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - John J. Chen
- Department of Ophthalmology, Mayo Clinic College of Medicine, Rochester, Minnesota
- Department of Neurology, Mayo Clinic College of Medicine, Rochester, Minnesota
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Abstract
PURPOSE OF REVIEW This article is intended to assist clinicians in distinguishing benign primary headache syndromes from serious headache presentations that arise from exogenous causes. RECENT FINDINGS Although most cases of severe headache are benign, it is essential to recognize the signs and symptoms of potentially life-threatening conditions. Patients with primary headache disorders can also acquire secondary conditions that may present as a change in their baseline headache patterns and characteristics. Clinical clues in the history and examination can help guide the diagnosis and management of secondary headache disorders. Furthermore, advances in the understanding of basic mechanisms of headache may offer insight into the proposed pathophysiology of secondary headaches. SUMMARY Several structural, vascular, infectious, inflammatory, and traumatic causes of headache are highlighted. Careful history taking and examination can enable prompt identification and treatment of underlying serious medical disorders causing secondary headache syndromes.
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Hadidchi S, Surento W, Lerner A, Liu CSJ, Gibbs WN, Kim PE, Shiroishi MS. Headache and Brain Tumor. Neuroimaging Clin N Am 2019; 29:291-300. [DOI: 10.1016/j.nic.2019.01.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Nursing Guide to Management of Major Symptoms in Patients with Malignant Glioma. Semin Oncol Nurs 2018; 34:513-527. [DOI: 10.1016/j.soncn.2018.10.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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Ozawa M, Brennan PM, Zienius K, Kurian KM, Hollingworth W, Weller D, Hamilton W, Grant R, Ben-Shlomo Y. Symptoms in primary care with time to diagnosis of brain tumours. Fam Pract 2018; 35:551-558. [PMID: 29420713 PMCID: PMC6142711 DOI: 10.1093/fampra/cmx139] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Background Brain tumours often present with varied, non-specific features with other diagnoses usually being more likely. Objective To examine how different symptoms and patient demographics predict variations in time to brain tumour diagnosis. Methods We conducted a secondary analysis of brain tumour cases from National Audit of Cancer Diagnosis in Primary Care. We grouped neurological symptoms into six domains (headache, behavioural/cognitive change, focal neurology, 'fits, faints or falls', non-specific neurological, and other/non-specific) and calculated times for patient presentation, GP referral, specialist consultation and total pathway interval. We calculated odds ratios (ORs) for symptom domains comparing the slowest to other quartiles. Results Data were available for 226 cases. Median (interquartile range) time for the total pathway interval was 24 days (7-65 days). The most common presentation was focal neurology (33.2%) followed by 'fits, faints or falls' and headache (both 20.8%). Headache only (OR = 4.11, 95% CI = 1.10, 15.5) and memory complaints (OR = 4.82, 95% CI = 1.15, 20.1) were associated with slower total pathway compared to 'fits, faints or falls'. GPs were more likely to consider that there had been avoidable delays in referring patients with headache only (OR = 4.17, 95% CI = 1.14, 15.3). Conclusion Patients presenting to primary care with headache only or with memory complaints remain problematic with potentially avoidable delays in referral leading to a longer patient pathway. This may or may not impact on the efficacy and morbidity of therapies. Additional aids are required to help doctors differentiate when to refer headaches and memory complaints urgently for a specialist opinion.
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Affiliation(s)
- Mio Ozawa
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Paul M Brennan
- Translational Neurosurgery Unit, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
- Brain Tumour Research Group, University of Bristol, Institute of Clinical Neuroscience, Learning and Research Building, Southmead Hospital, Bristol, UK
| | - Karolis Zienius
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Kathreena M Kurian
- Institute of Clinical Neurosciences, University of Bristol, Southmead Hospital, Bristol, UK
| | - William Hollingworth
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - David Weller
- Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK
| | - Willie Hamilton
- Primary Care Diagnostics, University of Exeter Medical School, College House, St Luke’s Campus, University of Exeter, Exeter, UK
| | - Robin Grant
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Yoav Ben-Shlomo
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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Nelson S, Taylor LP. Headaches in brain tumor patients: primary or secondary? Headache 2016; 54:776-85. [PMID: 24697234 DOI: 10.1111/head.12326] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/30/2014] [Indexed: 01/03/2023]
Abstract
BACKGROUND Headaches occur commonly in all patients, including those who have brain tumors. It has been argued that there is a classic "brain tumor headache type" - defined by the International Headache Society as one that is localized, progressive, worse in the morning, aggravated by coughing or bending forward, develops in temporal and often spatial relation to the neoplasm, and resolves within 7 days of surgical removal or treatment with corticosteroids. METHODS Using the search terms "headache and brain tumors," "intracranial neoplasms and headache," and "facial pain and brain tumors," we reviewed the literature from the past 20 years on brain tumor-associated headache and reflected upon the International Classification of Headache Disorders-3 (ICHD-3). In a separate, complementary paper, the proposed mechanisms of brain tumor headache are reviewed. RESULTS We discuss multiple clinical presentations of brain tumor headaches, present the ICHD-3 diagnostic criteria for each type of headache, and then apply our findings to the ICHD-3. Our primary and major finding was that brain tumor headaches can present similarly to primary headaches in those with a predisposition to headaches, suggesting that following ICHD-3 criteria could cause a clinician to overlook a headache caused by a brain tumor. We further find that some types of headaches are not explicitly discussed in the ICHD-3 and also propose that the International Headache Society formally define SMART (Stroke-like Migraine Attacks after Radiation Therapy) syndrome given the increasing amount of literature on this disorder. CONCLUSION Our literature review revealed that brain tumor headache uncommonly presents with classic brain tumor headache characteristics and often satisfies criteria for a primary headache category such as migraine or tension-type. Thus, clinicians may miss headaches due to brain tumors in following ICHD-3 criteria, and the distinction between primary and secondary headache disorders may not be so clear-cut.
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Affiliation(s)
- Sarah Nelson
- Departments of Neurology, Tufts Medical Center, Boston, MA, USA
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Faizi N, Khalique N, Ahmad A, Shah MS. The dire need for primary care specialization in India: Concerns and challenges. J Family Med Prim Care 2016; 5:228-233. [PMID: 27843818 PMCID: PMC5084538 DOI: 10.4103/2249-4863.192382] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Primary health care is an evidence-based priority, but it is still inadequately supported in many countries. Ironically, on one hand, India is a popular destination for medical tourism due to the affordability of high quality of health care and, on the other hand, ill health and health care are the main reasons for becoming poor through medical poverty traps. Surprisingly, this is despite the fact that India was committed to 'Health for All by 2000' in the past, and is committed to 'Universal Health Coverage' by 2022! Clearly, these commitments are destined to fail unless something is done to improve the present state of affairs. This study argues for the need to develop primary care as a specialization in India as a remedial measure to reform its health care in order to truly commit to the commitments. Three critical issues for this specialization are discussed in this review: (1) The dynamic and distinct nature of primary care as opposed to other medical specializations, (2) the intersection of primary care and public health which can be facilitated by such a specialization, and (3) research in primary care including the development of screening and referral tools for early diagnosis of cancers, researches for evidence-based interventions via health programs, and primary care epidemiology. Despite the potential challenges and difficulties, India is a country in dire need for primary care specialization. India's experience in providing low-cost and high quality healthcare for medical tourism presages a more cost-effective and efficient primary care with due attention and specialization.
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Affiliation(s)
- Nafis Faizi
- Department of Community Medicine, J. N. Medical College, AMU, Aligarh, Uttar Pradesh, India
| | - Najam Khalique
- Department of Community Medicine, J. N. Medical College, AMU, Aligarh, Uttar Pradesh, India
| | - Anees Ahmad
- Department of Community Medicine, J. N. Medical College, AMU, Aligarh, Uttar Pradesh, India
| | - Mohammad Salman Shah
- Department of Community Medicine, J. N. Medical College, AMU, Aligarh, Uttar Pradesh, India
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Abstract
PURPOSE OF REVIEW Papilledema is one of the most concerning physical examination findings in neurology: it has a broad differential diagnosis of intracranial (and occasionally spinal) pathology associated with increased intracranial pressure. Papilledema impairs axoplasmic flow within the optic nerves and compresses the optic nerves externally; it may lead to profound visual loss. Thus, detection of papilledema and assessment of visual function are essential to patient management. This article reviews the treatment of papilledema-related visual loss in pseudotumor cerebri syndrome, one of the most common causes of papilledema encountered by neurologists. RECENT FINDINGS Results from the Idiopathic Intracranial Hypertension Trial (IIHTT), the first randomized, double-masked, placebo-controlled trial for the treatment of patients with mild visual loss from idiopathic intracranial hypertension, were published in April 2014. The IIHTT provides the first evidence-based treatment recommendations, showing the benefit of acetazolamide and weight loss for improving visual status in patients with mild visual field loss from idiopathic intracranial hypertension. SUMMARY A detailed ophthalmic examination, including perimetry, is critical to the evaluation, treatment, and assessment of treatment response in patients with papilledema.
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Affiliation(s)
- Lynne P. Taylor
- Hematology-Oncology Department (Neuro-Oncology); Tufts Medical Center; Boston MA USA
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Levin M. Resident and Fellow Section. Headache 2012; 52:1202-3. [DOI: 10.1111/j.1526-4610.2012.02199.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Abstract
Although most people who have headache pain do not present with an underlying mass lesion, a large number of patients with brain tumors do report headache (as many as 60% in our institution). The problem for clinicians is that the tumor-headache association is not universal, as evidenced by anecdotal reports of patients with large tumors and increased intracranial pressure, but a complete absence of headache pain. In this review, we examine more than 80 years of research on brain tumor headaches, delineating the link between tumor location, laterality, growth rate, and pain. Most importantly, we position our review within the context of current etiological theories and propose new models involving the peripheral and central sensitization of nociresponsive neurons. This review will help clinicians understand why debulking surgery sometimes fails to alleviate neoplastic headache pain in select patients. A brief examination of headaches as a result of surgery and adjuvant chemoradiation therapy is also provided. Headaches can be an early indicator of central nervous system tumors. However, headaches are present in a wide variety of other condition, and are sometimes (surprisingly) absent in patients with primary neoplasms or metastatic tumors. This observation complicates the possibility of linking headaches to brain tumors. Nevertheless, some generalizations concerning brain tumor headaches can be drawn. The following sections review these generalizations, presenting caveats where appropriate. Lingering questions in the field are also addressed and presented together with promising future research avenues.
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Affiliation(s)
- Philippe Goffaux
- Department of Neurosurgery and Neuro-oncology, Université de Sherbrooke, Faculty of Medicine, Sherbrooke, Québec, Canada.
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Hamlat A, Saikali S, Diabira S, Messerer M, Riffaud L. Diagnosis of childhood astrocytomas. EXPERT OPINION ON MEDICAL DIAGNOSTICS 2009; 3:501-522. [PMID: 23495981 DOI: 10.1517/17530050903032679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND Astrocytomas are the most common brain tumours, accounting for 28 - 50% of all primary CNS tumours. Diagnosis of CNS tumours remains difficult because the varied and nonspecific presentations of CNS tumours in childhood. Objectives/method: The clinical presentations of CNS astrocytomas vary with their sites of location; therefore, a period of uncertainty often precedes diagnosis, and approximately 42% of patients with an intracranial process make several visits to various physicians between the onset and diagnosis. However, on clinical suspicion of a brain tumour, a wide range of neuroimaging techniques may be used to assess the diagnosis of paediatric brain lesions. In this review the authors, for ease of presentation, describe the clinical presentations of supratentorial, infratentorial and spinal cord astrocytomas as well as their radiological and pathological features, and discuss their differential diagnoses. RESULTS/CONCLUSIONS Understanding and mastering the numerous imaging features of several subtypes of primary brain tumours affecting children, in addition to radiological features of non-tumoural disorders, remains a significant challenge and demands increased awareness of the paediatric brain diseases.
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Affiliation(s)
- Abderrahmane Hamlat
- Department of Neurosurgery, CHU Pontchaillou, 2 Rue Henri Le Guilloux, 35000 Rennes Cedex 2, France +33 2 99 28 43 21 ; +33 2 99 28 41 80 ;
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Affiliation(s)
- Joshua M Cohen
- Headache Institute, St. Luke's-Roosevelt Hospital Center, USA
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Abstract
Brain tumors are the most common solid tumor of childhood. The presenting signs and symptoms reflect the nature and location of the tumor, the presence of increased intracranial pressure, and the age and development of the child. A detailed history and neurologic examination will, in most cases, identify children with intracranial neoplasms. Diagnosis is then confirmed by neuroradiologic studies, including computed tomography, MRI and magnetic resonance spectroscopy.
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Affiliation(s)
- Patricia K Duffner
- University at Buffalo School of Medicine, Hunter James Kelly Research Institute, Buffalo, NY, USA.
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Errante D, Bernardi D, Bianco A, Salvagno L. Comment on: incidence, pattern and timing of brain metastases among patients with advanced breast cancer treated with trastuzumab. Acta Oncol 2007; 46:565-6. [PMID: 17497328 DOI: 10.1080/02841860601099258] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Abstract
Headache is one of the most common somatic complaints of patients seeking medical care. Most headaches are not of serious cause and can be diagnosed easily with a good history and physical examination. The challenges to the physician are to determine when underlying intracranial pathology may be causing the symptoms and signs, and to identify the few patients in whom a tumor is the cause of the headache. The subject of headache in patients with brain tumors has been reviewed in neurologic textbooks and in several investigations before, as well as after, modern imaging diagnostic techniques became available. Headache can also manifest as an acute or chronic complication of radiation treatment and/or chemotherapy in patients with intracranial neoplasm, but there are few data in the literature specifically addressing this subject. This article provides an overview of headache in patients with primary and secondary brain tumor, including headache characteristics, the putative mechanism for these headaches, the role of diagnostic testing, and the general principles of management.
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Affiliation(s)
- Monica Loghin
- Neuro-Oncology Unit 431, UT MD Anderson Cancer Center, PO Box 301402, Houston, TX 77230, USA
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