Remember: Cerebral metastases are the most common tumours in the CNS.
History and Examination
For presentation of specific tumour types, please see Appendices 1 and 2.
The following are the key general modes of presentation of CNS tumours:
- Progressive focal neurological deficit:
Due to local mass effect, compression or invasion of surrounding neural structures.
Most common is a progressive motor deficit.Remember: Think carefully about the function of the different parts of the brain (see Chapter 3), and ask patients (or their carers) about any specific neurological deficits (including cognitive problems). Localise tumour on the basis of which functions have been lost, for example a Gerstmann’s syndrome may be due to a dominant parietal lobe tumour.
- Symptoms and signs of raised intracranial pressure:
See Chapter 30.
Headaches, mental status changes and papilloedema.- Seizures:
See Chapter 17.
Any new onset of seizure disorder in an adult should prompt detailed investigations for an underlying tumour.
Seizures rarely occur in posterior fossa tumours.- Hydrocephalus:
See Chapter 37.
Obstructive: Due to compression or obstruction of ventricular CSF pathways by tumour mass.
Communicating: Due to meningeal infiltration impairing CSF absorption.- Endocrine disturbance:
Tumours in and around the pituitary fossa may cause hypopituitarism (see Appendix 2) due to local mass effect disturbing pituitary function.Only gold members can continue reading. Log In or Register to continue
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