Clinical Manifestations of CNS Tumors

Supratentorial Tumors

Presentation and Symptoms - progressive neurologic deficit

dependent on location of lesion and surrounding edema
focal deficit and/or mental status change
headache
progressively worse, worse in morning
seizure

Most common types: glioma, meningioma, metastasis

Infratentorial Tumors

Cerebellar tumors

Presentation and Symptoms

obstructive hydrocephalus, increased intracranial pressure (ICP)
headache, nausea and vomiting (N/V), visual symptoms - diplopia, papilledema
ataxia

Brainstem Tumors

Presentation and Symptoms: cranial nerve and long tract signs

Common Types:

Adult: metastases, glioma
Pediatric: medulloblastoma, juvenile pilocytic astrocytoma (JPA), ependymoma, other gliomas

Intraventricular

Presentation and Symptoms - obstructive hydrocephalus, constant or intermittent

headache, ataxia, nausea/vomitting

Tumor Types: hypothalmaic glioma, colloid cyst, meningioma, ependymoma, choroid plexus papilloma, large sellar tumor (craniopharyngioma, pituitary adenoma), teratoma

Pineal Region Tumors

Presentation and Symptoms - hydrocephalus - headache, ataxia, nausea/vomitting

Perinaud’s syndrome - upgaze palsy

Tumor Types: pineocytoma, pineoblastoma, germinoma, teratoma, embryonal carcinoma, meningioma, dermoid, metastases, yolk sac tumor

Skull Base Tumors

(1) Sella Turcica - Pituitary Adenoma

Endocrine-active

usually presents when small (microadenoma)
secrete one or more anterior pituitary hormone

Endocrine-inactive

usually larger at presentation (macroadenoma)
compression of anterior pituitary and optic chiasm
visual loss, bitemporal hemianopia
hypopituitarism

(2) Parasellar - cavernous sinus tumor

Presentation and Symptoms: diplopia - CN III, IV and VI, facial sensory loss or pain - VI, V2, visual loss if extension to optic apparatus - II

Tumor Types: meningioma, schwannoma, chordoma, chondrosarcoma, pituitary adenoma, nasopharyngeal carcinoma, cavernous angioma, metastases

(3) Anterior Fossa

Presentation and Symptoms: loss of smell - CN I, personality/cognitive change, nasal congestion, eye pain

Tumor Types: meningioma, esthesioneuroblastoma chondrosarcoma, nasopharyngeal carcinoma

(4) Middle Fossa

Presentation and Symptoms: headache, visual loss (II), diplopia (III, IV, VI), facial pain, paresthesia (VI-3)

Tumor Types: meningioma, epidermoid/dermoid, chordoma

(5) Lateral Posterior Fossa

Presentation and Symptoms: lower cranial nerve palsies: VII - XII

Tumor Types: vestibular schwannoma, meningioma, glomus jugulare tumors, chordoma