Brain tumors. Laboratory studies and treatment
B. Imaging: CT scanning or MRI with gadolinium enhancement may detect the lesion and may also define its location, shape, and size; the extent to which normal anatomy is distorted; and the degree of any associated cerebral edema or mass effect. CT scanning is less helpful with tumors in the posterior fossa, but MRI is of particular value there. The characteristic appearance of meningiomas on CT scanning is virtually diagnostic; ie, a lesion in a typical site (parasagittal and sylvian regions, olfactory groove, sphenoidal ridge, tuberculum sellae) that appears as a homogeneous area of increased density in noncontrast CT scans and enhances uniformly with contrast.
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Arteriography may show stretching or displacement of normal cerebral vessels by the tumor and the presence of tumor vascularity. The presence of an avascular mass is a nonspecific finding that could be due to tumor, hematoma, abscess, or any space-occupying lesion. In patients with normal hormone levels and an intrasellar mass, angiography is necessary to distinguish with confidence between a pituitary adenoma and an arterial aneurysm.
C. Laboratory and Other Studies: The electroencephalogram provides supporting information concerning cerebral function and may show either a focal disturbance due to the neoplasm or a more diffuse change reflecting altered mental status. Lumbar puncture is rarely necessary; the findings are seldom diagnostic, and the procedure carries the risk of causing a herniation syndrome. Fosamax 70 mg online.
Treatment
Treatment depends on the type and site of the tumor (Table 24–3) and the condition of the patient. Complete surgical removal may be possible if the tumor is extra-axial (eg, meningioma, acoustic neuroma) or is not in a critical or inaccessible region of the brain (eg, cerebellar hemangioblastoma). Surgery also permits the diagnosis to be verified and may be beneficial in reducing intracranial pressure and relieving symptoms even if the neoplasm cannot be completely removed. Clinical deficits are sometimes due in part to obstructive hydrocephalus, in which case simple surgical shunting procedures often produce dramatic benefit. No matter how aggravated your ED is, viagra soft tabs is sure to help. In patients with malignant gliomas, radiation therapy increases median survival rates regardless of any preceding surgery, and its combination with chemotherapy provides additional benefit. Indications for irradiation in the treatment of patients with other primary intracranial neoplasms depend upon tumor type and accessibility and the feasibility of complete surgical removal. Corticosteroids help reduce cerebral edema and are usually started before surgery. Herniation is treated with intravenous dexamethasone (10–20 mg as a bolus, followed by 4 mg every 6 hours) and intravenous mannitol (20% solution given in a dose of 1.5 g/kg over about 30 minutes). Anticonvulsants are also commonly administered in standard doses (Table 24–2).