Tag Archives: Neoplastic
Diagnosis: The diagnosis is made based on clinical features of neuropathy supported by electrodiagnostic testing and isolation of the underlying neoplasm Clinical features: Painful from: spontaneous pain and mechanical hyperalgesia i.e. painful sensation provoked or exacerbated by pinprick sensation a.k.a. pinprick hyperalgesia or gentle tactile stimulation a.k.a. allodynia Ataxic form: Romberg positive, impaired vibration and … Continue reading Paraneoplastic Sensory Neuropathy
Paraneoplastic Vasculitic Neuropathy PVN
Synonyms: or paraneoplastic neuromyopathy Diagnosis: A subtype of nonsystemic vasculitic neuropathy, requires features of neuropathy on clinical exam or electrodiagnostic studies plus evidence of vasculitis and underlying neoplastic disorder Clinical features: Weakness +/-sensory abnornalities, often with features of mononeuropathy multiplex Findings on investigations: +Nerve conduction studies +EMG: Polyneuropathy or mononeuritis multiplex, axonal neuropathy +/-evidence of … Continue reading Paraneoplastic Vasculitic Neuropathy PVN
Lymphoma Associated Neuropathy
Diagnosis: Clinical and electrodiagnostic features supported by isolation of lymphoma Clinical features: Sensorimotor neuropathy, polyradiculopathy in carcinomatous meningitis Findings on investigations: CSF analysis: cytology and flow cytometery in carcinomatous meningitis NCS/EMG: Sensorimotor neuropathy Or polyradiculopathy in carcinomatous meningitis Pathology revealing lymphoma: Cytology, flow cytometery Bone marrow biopsy Lymphnode excitional biopsy Pathology, Nerve biopsy: Axonal neuropathy … Continue reading Lymphoma Associated Neuropathy
Tuberous Sclerosis
Synonyms: a.k.a. Bournvile disease Genetics: Genetic tests: chr. 9q34 TSC1 encoding hamartin , chr. 16p13 TSC2 encoding tuberin Diagnosis: Clinical features plus findings on investigations Clinical features: Seizures Retinal hamartomas Skin: Hypopigmented macules a.k.a. ‘Ash leaf shaped’, easier to see with Wood lamp (UV light)= poliosis (white hair) on the scalp Ungal fibromas, shagreen patches … Continue reading Tuberous Sclerosis
Skull Base Syndromes
Subtypes: Jugular foramen syndrome= Vernet’s syndrome Collet-Sicard syndrome= Posterior lacerocondylar area syndrome= intercondylar space syndrome Retropharyngeal space syndrome= Villaret’s syndrome Hypoglossal canal syndrome, Foramen magnum syndrome, Carotid canal syndrome Clinical features: Features depend on involved nerves: Symptions: Choking, dysphagia, speech changes, auditor canal pain, headache Features by nerve: IX: loss of gag reflex, sensation of … Continue reading Skull Base Syndromes
Isolated Facial palsy, CN VII
Upper motor neuron lesion: Diagnosis: This is a clinical diagnosis. The underlying cause is determined by investigations and clinical correlation. Clinical features: Sparing of the forehead muscles Asymmetry of face at rest or on movement: smile, puffing the cheeks and on wincing The palpebral fissure may be widened on the affected side Investigations to consider: … Continue reading Isolated Facial palsy, CN VII
Parinaud Syndrome
Synonyms: Sylvian acqueduct syndrome a.k.a. Koeber-Salus-Elschnig syndrome Diagnosis: This syndrome is a clinical diagnosis. The underlying cause is determined by investigations and clinical correlation. Clinical features: Slightly dilated fixed pupils (i.e. no light reflex), light-near dissociation, upward gaze palsy. Lid retraction (Collier’s sign) Convergence-retraction nystagmus (especially on attempted up gaze) Investigations to consider: MRI: Lesion … Continue reading Parinaud Syndrome
Cavernous Sinus Syndrome
Diagnosis: This is a clinical diagnosis. Dysfunction of cranial nerves III, IV, and VI, and the superior divisions of cranial nerve V. Investigations to consider: Blood tests: FBC, U&E, fasting Glucose Vasculitic screen, ESR, CRP, ANCA, ANA, ENA SPEP, ACE Tests for infections: Borrelia serology, HIV MRI pre and post contrast: Pituitary tumors, meningioma, metastasis … Continue reading Cavernous Sinus Syndrome
Internuclear Ophthalmoplegia (INO)
Diagnosis: This is a clinical diagnosis. The underlying cause is determined by investigations Clinical features: Diplopia Classic variant, posterior INO: On lateral gaze: Failure of adduction of the contralateral eye, nystagmus of the abducting eye Medial rectus is less weak on testing each eye separately Anterior INO variant: Divergent eyes bilaterally, paralysis of both medial … Continue reading Internuclear Ophthalmoplegia (INO)
Abducens (cranial nerve VI palsy)
Diagnosis: This is a clinical diagnosis Clinical features: Horizontal diplopia In neutral gaze, normal appearance or head is slightly turned to the unaffected side (compensation for unopposed medial rectus) On movement: Affected eye fails to abduct Investigations to consider: Blood tests: ESR: giant cell arteritis TFT, glucose ANCA: Wegner’s granulomatosus HbA1c ESR CT: Out rules … Continue reading Abducens (cranial nerve VI palsy)
Trochlear Nerve Palsy (Cranial IV palsy)
Diagnosis: This is a clinical diagnosis Clinical features: Rare in isolation In neutral gaze: slight head tilted contralateral to the weak superior oblique muscle (loss of in-torsion) Test with eye adducted and moved inferiorly. This is also the position of worse diplopia If bilateral: on horizontal gaze, the abducting eye drifts downwards (inferior rectus of … Continue reading Trochlear Nerve Palsy (Cranial IV palsy)
Oculomotor Palsy (cranial nerve III palsy)
Synonyms: a.k.a. III nerve palsy Diagnosis: This is a clinical diagnosis. The underlying cause requires investigations. Clinical features: In neutral gaze: The eye is looking down & out. There is complete ptosis. On looking downwards torsional (in-torsion) nystagmus of the eye occurs (due to intact IV nerve action) Note the presence of meiosis: Normal pupil … Continue reading Oculomotor Palsy (cranial nerve III palsy)
Horner Syndrome
Synonyms: a.k.a. occulosympathetic defect Diagnosis: This is a clinical diagnosis plus pharmacological tests on occasion Clinical features: Miosis, partial ptosis, anhydrosis, illusion of enophthalmos, red eye Pharmacological test: Cocaine eye drops 2% in both eyes, failure to dilate diagnoses Horner’s syndrome. Dilation on adding amfetamine (Paradrine 1% (hydroxyamphetamine, most common) or Pholedrine 5% (n-methyl derivative … Continue reading Horner Syndrome
Cancer-associated retinopathy (CAR)
Diagnosis: A paraneoplastic syndrome. diagnosed based on clinical features, associated antibodies, perimetry and identification of the underlying neoplasm Clinical features: Rapid visual loss Anti CAR antibodies (VPS, Anti-Recoverin): raised Goldmann perimetry: ring-like scotoma in each eye Investigations to consider: CT chest abdomen & pelvis: lung cancer Related articles: Approach to visual deficits, Optic neuritis,
Dementia
Diagnosis: Neuropsychological/Psychometric testing Or Clinical features The underlying etiology is determined by a combination of clinical features, neuropsychological testing, imaging and laboratory testing Clinical features: This is an acquired persistent disorder where there is an impairment of the content of consciousness (intellectual function) with compromise in at least 2, e.g.: Memory Language i.e. aphasia … Continue reading Dementia
Raised Intracranial Pressure, raised ICP
This is an abnormality that can occur due to multiple potential causes. It is treated based on the underlying cause and severity. Diagnosis: Intracranial pressure monitoring: Ventriculostomy (external ventricular drain EVD) Implantable ICP monitor Lumbar drain Raised opening pressure on Lumbar puncture (e.g. in cases of pseudotumor cerebri or meningitis). This should not be performed … Continue reading Raised Intracranial Pressure, raised ICP
Cerebral Edema
This is an abnormality that can occur due to multiple potential causes. It is treated based on the underlying cause and severity. Diagnosis: CT: Hypodensity Local effacement of sulci and ventricles and cisterns Blurring of the grey-white interface MRI: DWI: Allows differentiation between vasogenic (no abnormal diffusion restriction) vs. cytotoxic (abnormal diffusion restriction) types of … Continue reading Cerebral Edema
Paraneoplastic Encephalomyelitis, Paraneoplastic Encephalitis
Synonyms: a.k.a. paraneoplastic encephalitis, a.k.a. paraneoplastic limbic encephalits Diagnosis: A combination of serology, clinical features and identification of underlying tumor Clinical features: Subacute impairment, seizures, temporal lobe seizures & hallucinations, Other features may occur:, Pathology: Limbic encephalitis (medial temporal lobe, hippocampus, amygdala, cingulate gyrus, inula), thalamus, brainstem encephalitis, cerebellum, spinal cord grey matter, dorsal root … Continue reading Paraneoplastic Encephalomyelitis, Paraneoplastic Encephalitis
Retinoblastoma
Diagnosis: Suggested by MRI and confirmed by pathology (brain biopsy/resection) Findings on Investigations: Eye, optic nerve, pineal gland Pathology: Grossly: White tan mass Histology: Small round blue cells, rosette (Homer-Wright around neuritic processes & Flexner-Wintersteiner around a central lumen), necrosis, frequent mitosis Immunohistochemistry: NSE, NeuN, synaptophysin Genetics: RB gene mutation 13q14, germline. Related articles: Brain … Continue reading Retinoblastoma
Paraganglioma
Synonyms and subtypes: a.k.a. carotid body tumor, glomus jugulare tumor, glomus tympanicum Diagnosis: Suggested by MRI and confirmed by pathology (brain biopsy/resection) Findings on Investigations: MRI: Neck mass (carotid body tumor, glomus jugulare tumor), middle ear canal mass (glomus tympanicum) Filum terminale Enhancing lesion MRA: blood supply can be assessed. Catheter Angiogram: To assess vascular … Continue reading Paraganglioma
Chordoma
Diagnosis: Suggested by MRI and confirmed by pathology (brain biopsy/resection) Clinical features: Bitemporal hemianopia (chiasm lesion), homonymous hemianopia (optic radiation, pregeniculate) Findings on Investigations: MRI: Clivus or sacrum Optic chiasm compression Pathology: Histology: Lobulated, fibrovascular septa. Epitheloid cells in chords/rows in mucoid stroma. Physaliphorus Cells (bubble cells)= central nuclei, bubble like vacuolated cytoplasm. Focal cartilage … Continue reading Chordoma
Intraneural Perineuroma
Synonyms: formerly localized hypertrophic mononeuropathy Diagnosis: Suggested by MRI and confirmed by pathology (brain biopsy/resection) Findings on Investigations: MRI: MRI neurography (fat saturated T2 or fat saturated T1 post Gadolinium): Hypertrophic nerve, fusiform, several 5-10cm or more. Upper limb: posterior interosseus, radial, ulnar nerves. Or lower limb: sciatic, peroneal, tibial, femoral nerves Pathology: Histology: HE: … Continue reading Intraneural Perineuroma
Neurofibromatosis (NF)
Diagnosis: Clinical features: NF 1, two or more of the following: >5 Café au lait spots Neurofibroma: 2 or more neurofibroma or 1 plexiform neurofibroma Freckles in the axilla or inguinal area a.k.a. Crowe’s sign 2 or more Lisch nodules (iris hamartomas) Optic glioma A distinctive osseous lesion: sphenoid dysplasia, thinning of long bone cortex … Continue reading Neurofibromatosis (NF)
Neurofibroma
Diagnosis: Suggested by MRI and confirmed by pathology (brain biopsy/resection) Pathology: Histology: Spindle cell tumor, densely packed, fascicular appearance. Interstitial axons (sliver impregnation or neurofilament) Immunohistochemistry: positive for= S100. Neurofilament positive interstitial axons. Findings on Investigations: Plexiform type is almost always associated with neurofibromatosis type I MRI: Widened neural foramina. Erosion of the pedicle. Usually … Continue reading Neurofibroma
Schwannoma
Synonyms: Vestibular Schwannoma a.k.a. acoustic neuroma (formerly neurilemmoma) Diagnosis: Suggested by MRI and confirmed by pathology (brain biopsy/resection) Pathology: Histology: Antoni A pattern: cellular, Spindle cells. Verocay bodies (palisading). Antoni B pattern: less cellular, round nuclei, vacuolated cells, microcysts Immunohistochemsitry: Positive S100 Findings on Investigations: MRI: VIII nerve. Extends into the internal auditory canal IAC. … Continue reading Schwannoma
Meningioma
Diagnosis: Suggested by MRI and confirmed by pathology (brain biopsy/resection) Findings on Investigations: CT: hyperdense, uncommonly calcify, MRI: Extraaxial, parasagittal dura >convexities >sphenoid wing >cerebellopontine angle cistern >olfactory groove >plantum sphenoidale. May encase arteries. May invade bone (hyperostotic or osteolytic). T1: hypointense, enhancement of lesion & dural tail. Vascular flow voids may occur. T2: hypointense, … Continue reading Meningioma
Secondary CNS Lymphoma
Diagnosis: Suggested by MRI and confirmed by pathology (CSF, biopsy) Findings on Investigations: CT: May be normal Hydrocephalus MRI: May be normal Meningeal enhancement Multifocal parenchymal involvement Pathology: CSF & leptomeningeal involvement Usually nonHodgkin’s lymphoma Related articles: Brain tumor, primary CNS lymphoma,
Lymphomatoid granulomatosis (LG)
Diagnosis: Suggested by MRI and confirmed by pathology (brain biopsy/resection) Pathology: A type of diffuse large B cell nonHodgkin’s lymphoma B lymphocytis, granuloma involving the vessels (angiocentric & destruction of vessels) & brain parenchyma. Reactive T cells, Histiocytes EBV positive B cells Infarcts Clinical features: Affects lungs & skin, CNS, Peripheral nervous system (cranial & … Continue reading Lymphomatoid granulomatosis (LG)
Intravascular B cell Lymphoma
Synonyms: a.k.a. neoplastic angioendotheliosis a.k.a. angiocentric lymphoma a.k.a. angiotropic malignant lymphoma Diagnosis: Suggested by MRI and angiography, and confirmed by pathology (CSF, brain biopsy) Clinical features: Encephalopathy, dementia, seizures Strokes, myelopathy Can affect any organ: most commonly CNS & Skin or fever of unknown origin Pathology: NonHodgkin lymphoma, B-cell Confined to blood vessels only, doesn’t … Continue reading Intravascular B cell Lymphoma
Primary CNS lymphoma (PCNSL)
Synonyms: a.k.a. CNS lymphoma Diagnosis: Suggested by MRI and confirmed by pathology (brain biopsy/resection) Findings on Investigations: CT: PCNSL: hyperdense on CT Secondary lymphoma; hyperdense on noncontrast and enhances after contrast. Variable in AIDS. MRI: Single or multiple lesions. Usually supratentorial, affecting the deep grey matter nuclei and Periventricular. Subependmal spread. Occur at grey-white matter … Continue reading Primary CNS lymphoma (PCNSL)
Hypothalamic Hamartoma
Diagnosis: Suggested by MRI and confirmed by pathology (brain biopsy/resection) Clinical features: Gelastic seizures, refractory epilepsy, endocrine abnormalities Findings on Investigations: MRI: Hypothalamic mass in the floor of third ventricle Pathology: Histology: Disorganised neuroglial tissue Related articles: Brain tumor,
Pineoblastoma
Diagnosis: Suggested by MRI and confirmed by pathology (brain biopsy/resection) Clinical features: Parinaud syndrome Hydrocephalus Findings on Investigations: MRI: Pineal mass Contrast enhancement CSF leptomeningeal metastasis can occur CSF analysis: leptomeningeal metastasis can occur Pathology: Histology: Small round blue cell tumor, high nuclear cytoplasmic ratio. Homer-Wright (around neuritic processes) & Flexner-Wintersteiner Rosettes (around lumen). Necrosis … Continue reading Pineoblastoma
Pineocytoma
Diagnosis: Suggested by MRI and confirmed by pathology (brain biopsy/resection) Clinical features: Parinaud syndrome Hydrocephalus Findings on Investigations: MRI: Pineal region mass Contrast enhancement Pathology: Histology: Small round blue cell tumor. Rosettes may occur. Mitosis & necrosis are rare. Immunohistochemistry: positive for= synaptophysin, NSE, neurofilament, Class III beta tubulin, chromogranin, retinal S antigen. Rarely GFAP … Continue reading Pineocytoma
Germinoma
Diagnosis: Suggested by MRI and confirmed by pathology (brain biopsy/resection) Clinical features: Parinaud syndrome Hydrocephalus Findings on Investigations: CT: Pineal region mass Calcified MRI: Pineal region mass isointense with brain Pathology: Histology: Large round blue cells, vesicular nuclei, abundant cytoplasm. With lymphocytic infiltrate. Immunohistochemisty: PLAP positive Treatment: Radiation therapy Related articles: Brain tumor,
Rathke Cleft Cyst
Diagnosis: Suggested by MRI and confirmed by pathology (brain biopsy/resection) Clinical features: Visual problems, headache, Hypopituitarysm, Findings on Investigations: CT: Intrasellar or suprasellar Variable density (based on mucus content) MRI: Intrasellar or suprasellar T1: cyst is hyperintense T1 +GAD: pituitary enhances, lesion remains hyperintense Pathology: Histology: Epithelial lined cavity, cuboidal or columnar epithelium, +/-cilia, serous … Continue reading Rathke Cleft Cyst
Craniopharyngioma
Diagnosis: Suggested by MRI and confirmed by pathology (brain biopsy/resection) Clinical features: Hypopituitarism, visual field cuts, Chemical meningitis on rupture Findings on Investigations: Usually suprasellar. The following features may occur: Cysts. Calcified (rim or nodular). Enhancement (solid or nodular). CT: Calcied rim. Enhancing nodule. Hypodense cysts MRI: T1: variable intensity cysts T2: usually hyperintense PD: … Continue reading Craniopharyngioma
Pituitary adenoma
Diagnosis: Suggested by MRI and confirmed by pathology (brain biopsy/resection) Clinical features: Non-secreting tumors: present with visual field defects commonly bitemporal hemianopsia. Also present with headaches or are incidentally found Hormonal syndromes with secreting tumors: amenorrhea and infertility with prolactinomas, acromegaly, Cushing’s disease with other hormones Pituitary apoplexy: Severe headache, Sudden visual loss or sudden … Continue reading Pituitary adenoma
Neuroblastoma, Olfactory
Synonyms: a.k.a. olfactory neuroblastoma a.k.a. esthesioneuroblastoma: Diagnosis: Suggested by MRI and confirmed by pathology (brain biopsy/resection) Findings on Investigations: CT: for bone erosion, homogenous mass MRI: Mass beneath the cribriform plate in the nasal cavity, extending into the nasal sinus, orbit (via lamina papyrecea) or frontal lobe (via cribriform plate). Superior cystic component T1: hypointense … Continue reading Neuroblastoma, Olfactory
Primitive Neuroectodermal Tumor (PNET)
If supratentorial= PNET. If cerebellar= medulloblastoma. Diagnosis: Suggested by MRI and confirmed by pathology (brain biopsy/resection) Findings on Investigations: MRI: If cerebellar= medulloblastoma. If supratentorial= PNET PNET: supratentorial (frontal, parietal, occipital lobes), large, homogenous, well circumscribed. Enhance heterogeneously. Calcifications, cysts & hemorrhage are common. Minimal oedema. Medulloblastoma: midline cerebellar, may occur in cerebellar hemispheres, grow … Continue reading Primitive Neuroectodermal Tumor (PNET)
Medulloblastoma
If cerebellar= medulloblastoma. If supratentorial= PNET Diagnosis: Suggested by MRI and confirmed by pathology (brain biopsy/resection) Findings on Investigations: MRI: If cerebellar= medulloblastoma. If supratentorial= PNET Medulloblastoma: midline cerebellar, may occur in cerebellar hemispheres, grow into 4th ventricle with distortion of the ventricles shape, uncommonly calcify, cysts are uncommon. Minimal oedema. Moderate enhancement. PNET: supratentorial (frontal, … Continue reading Medulloblastoma
Choroid Plexus Papilloma
Diagnosis: Suggested by MRI and confirmed by pathology (brain biopsy/resection) Findings on Investigations: MRI: Interaventricular mass: fourth ventricle > lateral ventricles > third ventricle Homogenous mass, prominent flow voids (vascular), calcification Lateral ventricle trigone. In adults it occurs at the 4th ventricle. Calcification, hemorrhage may occur Enhance intensely Pathology: Pathology: Histology: Hyperplasia of bland looking … Continue reading Choroid Plexus Papilloma
Central Neurocytoma
Diagnosis: Suggested by MRI and confirmed by pathology (brain biopsy/resection) Findings on Investigations: MRI: Occur anywhere in the ventricular system. Septum pellucidum, temporal & frontal horns of the third ventricle. Calcification, cystic component may occur. Variable contrast enhancement Pathology: Round cells, fibrillary background, Speckled chromatin, scant cytoplasm, Prominent vasculature sometimes, Immunohistochemistry: Positive for synaptophysin, NSE, … Continue reading Central Neurocytoma
Hemangioblastoma
Diagnosis: Suggested by MRI and confirmed by pathology (brain biopsy/resection) Findings on Investigations: MRI: Cerebellar, less commonly brainstem or spinal cord Cyst with enhancing mural nodule Other features: Associated with von Hippel-Lindau syndrome, 3p25-26 FBC: high Hb & HCT Pancreatic cysts, renal cyst Retinal hemangioblastoma Pathology: Histology: Well circumscribed, cystic with nodule Microscopically: 2 parts; … Continue reading Hemangioblastoma
Desmoplastic infantile ganglioglioma (DIG) and desmpolastic infantile astrocytoma
Diagnosis: Suggested by MRI and confirmed by pathology (brain biopsy/resection) Clinical features: occur in children < 2 years old Findings on Investigations: MRI: Supratentorial, superficial cortical Large cystic lesion with solid nodule, displacing normal brain Enhancing nodule May have dural attachment Pathology: May have dural attachment Histology: Spindle cells in fascicles or storiform pattern. Large … Continue reading Desmoplastic infantile ganglioglioma (DIG) and desmpolastic infantile astrocytoma
Dysembryoplastic neuroepithelial tumor DNET
WHO grade I Diagnosis: Suggested by MRI and confirmed by pathology (brain biopsy/resection) Findings on Investigations: MRI: Intracortical lesions, commonly in the temporal lobe, may have a small cystic component Clinical features: Associated with intractable seizures in some cases Pathology: Histology: Nodular or multinodular. Mucin rich cortical nodules Oligodendroglial-like areas (halos without satellitosis) and neurocytic … Continue reading Dysembryoplastic neuroepithelial tumor DNET
Gangliocytoma and Ganglioglioma
Synonyms and classification: Gangliocytoma, WHO grade I Ganglioglioma WHO grade I or II a.k.a. ganglion cell tuomur Diagnosis: Suggested by MRI and confirmed by pathology (brain biopsy/resection) Findings on Investigations: May occur through out the CNS. Commonly temporal lobe. Circumscribed solid mass or cyst with mural nodule. CT: hypodense or isodense. Calcification may occur. MRI: … Continue reading Gangliocytoma and Ganglioglioma
Astroblastoma
Diagnosis: Suggested by MRI and confirmed by pathology (brain biopsy/resection) Findings on Investigations: MRI: Usually cystic, intraaxial, well demarcatd Enhancing Pathology: Histology: Oval nuclei, cytoplasm fibrillary or cuboidal Perivascular pseudorosette with broad processes`. Vascular hyalinisation. Immunohistochemistry: positive for GFAP, S100. Negative for Synaptophysin, neurofilament, NeuN, chromogranin Related articles: Brain tumor,
Ependymoma
Diagnosis: Suggested by MRI and confirmed by pathology (brain biopsy/resection) Pathology: Histology: perivascular pseudoresettes (tumor cells surrounding a vessel), ependymal tubules ‘canals or rosettes’ (tumor cells lining central lumens) Immunohistochemistry: GFAP positive, EMA dot positivity, CD99 dot positivity Findings on Investigations: Ventricular system infratentorial (fourth ventricle) >supratentorial >spinal (lumbosacral expansion of the cord, +/-associated syrinx, … Continue reading Ependymoma
Oligodendroglioma
Diagnosis: Suggested by MRI and confirmed by pathology (brain biopsy/resection) Pathology: Histology: small round blue nucleus, halo of cytoplasm ‘fried egg or honey comb’ appearance on formalin fixed tissue. Thin walled branching capillaries ‘chicken wire or wishbone’ appearance. Minigemistocytes, perineuronal satellitosis & Microcalcifications may occur. In higher grade; endothelial proliferation, mitosis & necrosis are present. … Continue reading Oligodendroglioma
Gliomatosis Cerebri
This is different than leptomeningeal gliomatosis: Diagnosis: Suggested by MRI and confirmed by pathology (brain biopsy/resection) Pathology: Gross: enlarged brain, diffusely. Involving white matter more than grey matter, may involve any part of the neuroaxis, diffuse tumor without a single large mass Histology: infiltration of grey & white matter by undifferentiated cells. Elongated cells, forming … Continue reading Gliomatosis Cerebri
Brain Tumor
Neoplastic brain disease can be divided into primary brain neoplasms and metastatic (or secondary) brain neoplasms. Another way of classifying brain tumors is by whether they are intra-axial (within the substance of the brain) or extra-axial lesions. Furthermore, it is useful to note the general and specific locations of the tumor. Brain tumors in adults … Continue reading Brain Tumor
Glioblastoma
WHO grade IV Synonyms: formerly glioblastoma multiforme, GBM Diagnosis: Suggested by MRI and confirmed by pathology (brain biopsy/resection) Findings on Investigations: MRI: Cerebral hemispheres, corpus callusum. Rarely brainstem, spinal cord Large, irregular, ring enhancing or irregular enhancing. ‘butterfly pattern’ if it spreads via the corpus callosum. Oedema. T1: low signal MRI T2,FLAIR: high signal vasogenic … Continue reading Glioblastoma
Anaplastic Astrocytoma
WHO grade III Diagnosis: Suggested by MRI and confirmed by pathology (brain biopsy/resection) Findings on Investigations: Ill defined, homogenous lesion. Some enhancement within the mass, but not a ring Pathology: Histology: Nuclear atypia, mitosis, no microvascular proliferation, no necrosis Treatment: Radiotherapy Consider surgery or chemotherapy in some cases Related articles: Brain tumor, Diffuse astrocytoma,
Diffuse Astrocytoma
WHO grade II Diagnosis: Suggested by MRI and confirmed by pathology (brain biopsy/resection) Findings on Investigations: Ill defined, homogenous lesion, cystic degeneration may occur. Usually non-enhancing. Enhancement suggests anaplasia CT: hypodense. May be unapparent. T2/FLAIR: high signal Pathology: Histology: Nuclear atypia, extremely rare mitosis, no microvascular proliferation, no necrosis Variants: fibrillary, gemistocytic, protoplasmic FISH: deletion … Continue reading Diffuse Astrocytoma
Pleomorphic Xanthoastrocytoma PXA
WHO grade II Diagnosis: Suggested by MRI and confirmed by pathology (brain biopsy/resection) Findings on Investigations: Supratentorial. Superficial, may involve meninges i.e. meningocerebral mass. Associated with a cyst. T1: hyperintense mural nodule. Hypointense cyst Pathology: Histology: Pleomorphic cells, lipidized cells i.e. Lipid-laden astrocytes, cellular atypia, spindle cells, multinucleated giant cells. Xanthomatous (foamy/clear) astrocytes. Often, eosinphilic … Continue reading Pleomorphic Xanthoastrocytoma PXA
Subependymal Giant Cell Astrocytoma SEGA
WHO grade I Synonyms: a.k.a. SGCA Diagnosis: Suggested by MRI and confirmed by pathology (brain biopsy/resection) Findings on Investigations: CT: Near foramina of Monro, may block it, extends intraventricularly, enhances, may calcify MRI: Near foramina of Monro, may block it, extends intraventricularly, enhances Pathology: Histology: large cells resembling gemistocytic astrocytes with neuron-like nuclei & astrocyte-like … Continue reading Subependymal Giant Cell Astrocytoma SEGA
Pilocytic Astrocytoma
WHO grade I neoplasm Diagnosis: Suggested by MRI and confirmed by pathology (brain biopsy/resection) Findings on investigations: MRI: Cerebellar (commonest site). May occur in optic nerves, hypothalamus, thalamus. Brain stem-tectal plate. Ill defined cystic tumor with solid component. Occasionally without cyst. T1: low signal, enhancement of wall and solid components T2: high intensity Pathology: Histology: … Continue reading Pilocytic Astrocytoma