北京大学神经内科教程——脑瘤.pptVIP

BRAIN TUMORSN Engl J Med Sun Yong’an The term “brain tumor” refers to a collection of neoplasms, each with its own biology, prognosis, and treatment; these tumors are better identified as “intracranial neoplasms,” since some do not arise from brain tissue (e.g., meningiomas and lymphomas). However, for most intracranial tumors, the clinical presentation, diagnostic approach, and initial treatment are similar. This night we will focus on general presentation, diagnosis, and specific treatment. EPIDEMIOLOGY The American Cancer Society estimates that 16,800 new intracranial tumors were diagnosed in 1999, more than double the number of diagnosed cases of Hodgkin’s disease and over half the number of cases of melanoma Ionizing radiation is the only unequivocal risk factor that has been identified for glial and meningeal neoplasms. Irradiation of the cranium, even at low doses, can increase the incidence of meningiomas by a factor of 10 and the incidence of glial tumors by a factor of 3 to 7,with a latency period of 10 years to more than 20 years after exposure. No other environmental exposure or behavior has been clearly identified as a risk factor. The use of cellular telephones, exposure to high-tension wires, the use of hair dyes, head trauma, and dietary exposure to N-nitro-sourea compounds or other nutritional factors have all been reported to increase the risk of brain tumors; however, the data are conflicting and unconvincing. CLINICAL PRESENTATION Brain tumors can cause either focal or generalized neurologic symptoms. Generalized symptoms reflect increased intracranial pressure and consist of headache and, when the illness is. Focal symptoms and signs, such as hemiparesis and aphasia, reflect the intracranial location of the tumor. The severe, nausea, vomiting, and a sixth-nerve palsy frequency and duration of symptoms vary with the type of tumor. For example, a rapidly evolving hemiparesis is more typical of a high-grade than a low-grade glioma. Headache occ