Hauser Pter Anamnesis 1 5 year old female

Anamnesis 1. • • 5 -year old, female II/2 normal pregnancy, pvn, 3200 g

Anamnesis 2. • last 3 months: – daily headache – daily retches – vomitus

Headche dd common upper airway infections fever viral infection sinusitis, otitis dental problem visual

Symptoms of increased ICP • • • Headache Nausea vomiting (especially morning) stiffneck papilledema

Causes of increased ICP • Mass effect (CNS bleeding, tumor) • Oedema (meningitis, encephalitis,

When to think about brain tumor? Headche + Neurological sign or symptom and/or Symptoms

Neurological signs (localization dependent) • Infratentorial: ICP + ataxia, coordnation disturbances • Supratentorial: ICP

Diagnosis • essential: THINK OF IT ! • thorough neurological examination • MRI (brain+spine)

Histology based on localization • Supratentorial: astrocytoma (A 1 -4) (50%) PNET ependymoma •

Chemosensitivity • • Medulloblastoma Germ cell tumors AT/RT PNET Astrocytoma G 1 Glioblastoma multiforme

Slides: 13

Download presentation

Hauser Péter

Anamnesis 1. • • 5 -year old, female II/2 normal pregnancy, pvn, 3200 g previous anamnesis: upper airway infections 3 months before: – diarrhoea, vomiting – no apetite, headche, abdominal pain – no fever

Anamnesis 2. • last 3 months: – daily headache – daily retches – vomitus every 2 -3 days – appointment to gastroenterologist • some days later: – increasing headache

Headche dd common upper airway infections fever viral infection sinusitis, otitis dental problem visual disturbances dehydration trauma sunstroke starvation hypotension psychological imitation rare hypertension migraine meningitis encephalitis CNS bleeding CNS tumors

Symptoms of increased ICP • • • Headache Nausea vomiting (especially morning) stiffneck papilledema bulging fontanelle, increasing head circumference (<1, 5 yrs) • (Bradypnoe) • (Bradycardia)

Causes of increased ICP • Mass effect (CNS bleeding, tumor) • Oedema (meningitis, encephalitis, hypoxia, vasculitis, metabolic disturbances) • CSF-flow blockade (hydrocephalus, VP-shunt blockade)

When to think about brain tumor? Headche + Neurological sign or symptom and/or Symptoms of increased ICP (symptoms are usually not specific to tumor !!!)

Neurological signs (localization dependent) • Infratentorial: ICP + ataxia, coordnation disturbances • Supratentorial: ICP + blurred vision localization dependent signs, epilepsy, behavioral changes • Brainstem: cerebral nerve palsy ataxia hemiparesis • Hormonal disturbances (corpus pineale, hypophysis)

Diagnosis • essential: THINK OF IT ! • thorough neurological examination • MRI (brain+spine) • Opus – histology • CSF sampling

Histology based on localization • Supratentorial: astrocytoma (A 1 -4) (50%) PNET ependymoma • Infratentorial: astrocytoma (A 1 -2) (35%) medulloblastoma ependymoma (E 1 -3) • Brainstem: (15%) astrocytoma (A 1 -4) • Pineal region : germ cell tumors PNET

Chemosensitivity • • Medulloblastoma Germ cell tumors AT/RT PNET Astrocytoma G 1 Glioblastoma multiforme Plexus choroideus cc

Therapy planning Histology Surgery Age Extent of resection Molecular profile irradiation High dose chemotherapy with stem cell rescue (ABMT) Chemotherapy Molecular th