Brain Tumors

Dexamethasone first for edema; surgical resection + radiation/chemo per type.

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◆Symptomatic mass lesions

•Progressive headache + focal deficits + new seizures + vasogenic edema → IV dexamethasone (stabilizes BBB)
•Mannitol is for cytotoxic edema / impending herniation
•AVOID lumbar puncture (herniation risk)

•Brain metastases: multiple ring-enhancing at gray-white junction (lung, breast, melanoma); SRS for limited, WBRT for many
•Meningioma: extra-axial dural-based mass in middle-aged woman; 'dural tail'; NF2; observe small asymptomatic
•Vestibular schwannoma (acoustic neuroma): progressive unilateral SNHL + tinnitus + imbalance; MRI IAC; bilateral → NF2
•Glioblastoma multiforme: large irregular rim-enhancing mass crossing corpus callosum ('butterfly'); Stupp protocol (resection + RT + temozolomide)
•Craniopharyngioma: child + bitemporal hemianopsia + GH/DI deficiency + calcified suprasellar mass

•NF1: café-au-lait, Lisch nodules, axillary freckling, optic gliomas
•NF2: bilateral vestibular schwannomas — annual brain MRI + audiometry
•Tuberous sclerosis: ash leaf spots, shagreen patch, subependymal nodules → SEGAs; cardiac rhabdomyomas; renal AML; vigabatrin for infantile spasms
•Sturge-Weber: port-wine stain + leptomeningeal angioma + seizures
•Von Hippel-Lindau: hemangioblastomas, RCC, pheochromocytoma

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