Notes
Oncology
Brain Tumors
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Oncology
Brain Tumors
Dexamethasone first for edema; surgical resection + radiation/chemo per type.
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Symptomatic mass lesions
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Progressive headache + focal deficits + new seizures + vasogenic edema → IV dexamethasone (stabilizes BBB)
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Mannitol is for cytotoxic edema / impending herniation
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AVOID lumbar puncture (herniation risk)
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Tumor types
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Brain metastases: multiple ring-enhancing at gray-white junction (lung, breast, melanoma); SRS for limited, WBRT for many
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Meningioma: extra-axial dural-based mass in middle-aged woman; 'dural tail'; NF2; observe small asymptomatic
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Vestibular schwannoma (acoustic neuroma): progressive unilateral SNHL + tinnitus + imbalance; MRI IAC; bilateral → NF2
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Glioblastoma multiforme: large irregular rim-enhancing mass crossing corpus callosum ('butterfly'); Stupp protocol (resection + RT + temozolomide)
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Craniopharyngioma: child + bitemporal hemianopsia + GH/DI deficiency + calcified suprasellar mass
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Phakomatoses
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NF1: café-au-lait, Lisch nodules, axillary freckling, optic gliomas
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NF2: bilateral vestibular schwannomas — annual brain MRI + audiometry
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Tuberous sclerosis: ash leaf spots, shagreen patch, subependymal nodules → SEGAs; cardiac rhabdomyomas; renal AML; vigabatrin for infantile spasms
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Sturge-Weber: port-wine stain + leptomeningeal angioma + seizures
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Von Hippel-Lindau: hemangioblastomas, RCC, pheochromocytoma
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