Astrocytoma is the MC supratentorial (but commonly infratentorial in childhood) Clinical features: Although many of these tumors can be benign, they are LESIONS and can interfere with brain function and can produce symptoms of: High ICP headache, vomiting (worse when waking) Seizures, ataxia, drowsiness/irritability Can produce signs of: Enlarged bulging fontanels (ICP) CN6 palsy and other CN palsies (ICP or direct) Nystagmus, papilledema (ICP) Sunset eyes (pinealoma producing Perinaud syndrome) Diminished vision (optic glioma) Bitemporal hemianopia, hypopituitarism (cranipharyngioma) Clinical features of specific tumors: Pilocytic astrocytoma (glioma) Well-circumscribed; commonly found in posterior fossa On MRI: (dark color) + (solid; cystic part mural nodule white color) Benign; good prognosis Gliobastoma multiforme (high grade astrocytoma) is commonly SUPRATENTORIAL, can sometimes cross the corpus callosum (butterfly glioma) and has a very poor prognosis; seizures, hemiplegia and neurological deficits common Medulloblastoma Highly malignant cerebellar tumor (it is a PNET) Can compress 4th ventricle hydrocephalus Truncal ataxia, coordination difficulty Can produce drop metastasis to spinal cord Brainstem glioma CN defects (facial palsy, drooling), pyramidal tract signs, cerebellar signs (e.g. ataxia), but no increased ICP S&S Often not biopsied (too dangerious) Very poor prognosis (<10% survival) Craniopharyngioma From remnants of Rathke’s pouch Causes childhood bitemporal hemianopia (always exclude this in children with hypopituitarism), growth failure, DI Most common childhood supratentorial tumor Pinealoma
Astrocytoma is the MC supratentorial (but commonly infratentorial in childhood) Clinical features: Although many of these tumors can be benign, they are LESIONS and can interfere with brain function and can produce symptoms of: High ICP headache, vomiting (worse when waking) Seizures, ataxia, drowsiness/irritability Can produce signs of: Enlarged bulging fontanels (ICP) CN6 palsy and other CN palsies (ICP or direct) Nystagmus, papilledema (ICP) Sunset eyes (pinealoma producing Perinaud syndrome) Diminished vision (optic glioma) Bitemporal hemianopia, hypopituitarism (cranipharyngioma) Clinical features of specific tumors: Pilocytic astrocytoma (glioma) Well-circumscribed; commonly found in posterior fossa On MRI: cystic part (dark color) + mural nodule (solid; white color) Benign; good prognosis Gliobastoma multiforme (high grade astrocytoma) is commonly SUPRATENTORIAL, can sometimes cross the corpus callosum (butterfly glioma) and has a very poor prognosis; seizures, hemiplegia and neurological deficits common Medulloblastoma Highly malignant cerebellar tumor (it is a PNET) Can compress 4th ventricle hydrocephalus Truncal ataxia, coordination difficulty Can produce drop metastasis to spinal cord Brainstem glioma CN defects (facial palsy, drooling), pyramidal tract signs, cerebellar signs (e.g. ataxia), but no increased ICP S&S Often not biopsied (too dangerious) Very poor prognosis (<10% survival) Craniopharyngioma From remnants of Rathke’s pouch Causes childhood bitemporal hemianopia (always exclude this in children with hypopituitarism), growth failure, DI Most common childhood supratentorial tumor Pinealoma