Includes memory problem, mood or personality disorders
It is the presenting symptom in 30-35% of patients with brain metastasis.
Patients symptoms often subtle, complain of fatigue, urge to sleep and loss of interest in daily activities. Confused with depression.
Consider neuroimaging in patients who present with new onset of depressive symptoms or without obvious cause.
76 yo old female presented with increased irritability with her family, sleeplessness and reckless spending.
PMH: HTN, breast cancer
PE, labs –wnl
MSE notable for loud rapid speech, flight of ideas, no delusions or hallucinations
CT revealed a 3 cm intraventricular lesion
Meningioma was removed and sxs slowly abated
Brain Meningioma CT
Meningioma MRI /T2
Neuroimaging of brain tumors
Major diagnostic modality. Useful for preoperative planning
The diagnosis of a primary brain tumor is best made by cranial MRI. This should be the first test obtained in a patient with signs or symptoms suggestive of an intracranial mass. The MRI scan should always be obtained both with and without contrast material (gadolinium).
MRI superior to CT scan for evaluating meninges, subarachnoid space, posterior fossa and defining the vascular abnormality of the lesion
High-grade or malignant gliomas appear as contrast-enhancing mass lesions, which arise in white matter and are surrounded by edema
Multifocal malignant gliomas are seen in ~ 5% of patients.
Low-grade gliomas typically are nonenhancing lesions that diffusely infiltrate brain tissue and may involve a large region of brain. Low-grade gliomas are usually best appreciated on T2-weighted MRI scans.
A contrast-enhanced CT scan may be used if MRI is unavailable. CT may be false-negative in patients with a low-grade tumor and can have significant artifact through the posterior fossa, which may obscure a lesion in this area.
Calcification, which may suggest the diagnosis of an oligodendroglioma, is often better appreciated on CT than on MRI.
CT useful if there is a question of bone or vascular involvement, or for detecting mets to skull base. Also, in ER situation or if MRI is contraindicated.
Radiologic features of metastatic disease -Multiple lesions -Localization at the grey-white junction -More circumscribed margins -Relatively large amount of edema compared to size of lesion
Wen, Patrick Y. Overview of Brain Metastases. UptoDate version 13.3.
Wong, Eric T. Clinical presentation and diagnosis of brain tumors. UptoDate version 13.3.
Ma, Julie. Mania Resulting from Brain Tumor. Clinical Vignette UCLA Department of Medicine.