2. CNS Neoplasia Presented By: Joseph S. Ferezy, D.C.

3. Primary Tumors 80% of All CNS Tumors Gliomas (Non-neuronal Tissue) 45% Astrocytoma Benign Commonest in Children May Become Malignant (Glioblastoma Multiform) at Any Time Peak Incidence @ 30-40 Yrs. Or Child Usually Frontal Unilateral HA or Generalized Skull Films Show Displaced Calcified Pineal Gland, CT Scan Cerebral or Cerebellar

4. Primary Tumors Glioblastoma Multiforme Most Common in Adult Usually 50-60 Yrs. Malignant Rapid Progression

5. Primary Tumors Oligodendrogliomas Adults Cerebral 30-40 Yrs. Chronic Ha & Seizures Maybe Only Symptoms

6. Primary Tumors Epenymoma A Slow Growing, Calcific, Ventricular Wall Tumor (Usually 4 th Ventricle), Occurring Most Often in Children. Signs and Symptoms of Increased Intracranial Pressure – Short Average Survival Cells Lining Ventricles & Central Canals Common in Childhood Increase Intracranial Pressure = Nausea, Vomiting, Papilledema

7. Primary Tumors Choroid Plexus Papilloma Rare & Found in Children Associated Hydrocephalus Medulloblastoma 2 nd Most Common in Child Usually in Cerebellar Vermis Highly Malignant Male:female 2-3:1 Ataxia and Cerebellar Vermis Syndrome

8. Primary Tumors Pinealoma In Area of Pineal Gland Increased Intracranial Pressure Pituitary Ademona Anterior Pituitary = 10% of All Intracranial Tumors Mid Age or Older Hormone Secretion or Hypopituitaryism Caused by Compression

9. Primary Tumors Meningioma There Are Many Types of Meningiomas, for the Most Part They Are Slow Growing, Benign Tumors Which Cause Signs of Compression Relating the Their Location. They Are of Mesodermal Origin. Benign, Slow Growing From Vascular Elements of Meninges 10% of Intracranial Tumors Older Patients – More Frequently Women Signs Depends on Location

10. Primary Tumors Neurilemomas (Neurinoma, Schwannoma) A Slow Growing, Benign Tumor of Mesodermal Origin, Usually on CN VIII (Acoustic Neurinoma). Tinnitus, Hearing Loss, Vertigo, CN V and VII Signs, and Finally, As It Fills the Cerebellopontine Angle, Cerebellar Signs Develop. There Are Two Types of Nerve Tumors: True Neuromas These Are Very Rare and Are Composed of Actual Nerve Tissue. They Are Associated With the Sympathetic System, and Often Multiple. False Neuromas

11. Arise From the Connective Tissue of the Nerve Trunk. Often in Multiple Numbers Along the Spinal Nerves. Examples Include, Neurofibromatosis and Plexiform Neuromas. Slow and Benign Tinitus, Hearing Loss, Vertigo Effects V & VII With Associated Symptoms Cerebellar Signs

12. Primary Tumors Craniopharyngioma Congenital Usually Detected by Age 30 Male:female 3:2 Increase ICP

13. Primary Tumors Hemangioblastoma Usually Cerebellar Vermis or Cord Syrinx 30-40 Yrs. Males With Cysts and Tumors of Liver, Pancreas and Kidneys Is Termed Lindau’s Syndrome - With Additional Retinal Angioma = Von-hipple- lindau Syndrome

14. Primary Tumors Colloid Cysts of the 3 rd Ventricle Rare Congenital Lesion Valve Effect Causes Headaches Relieved and Initiated by Certain Postures

15. Primary Tumors Dermoid & Epidermoid Cysts (Pearly Tumors) Chordoma (Notochord) 30-70 Yrs. 2:1 Males Sacrococcygeal or Clivus Arachnoid Cysts CSF Cysts in Arachnoid Space Common in Infants or Young Child May Be Bulging

16. Metastatic Neoplasms Usually Carcinomas Spread From the Lungs or Breast, Less Frequently From the Thyroid or Gastrointestinal System. Metastasis to the CNS Comprises Only 20% of All Intracranial Masses. Metastasis to the Vertebra (Osteoblastic or Osteolytic) Is Much More Common Due to the Increased Venous Vascularity. 20% of All Intracranial Neoplasms Most Common From Lung (35%), Breast (20%), Melanomatous (10%), Gastrointestinal (10%), Kidney (5%) Genitourinary and Endocrine 40-70 Yrs. Usually Through Arterial System Usually Middle Cerebral Artery

17. Meningeal Carcinomatosis Least Common Usually Breast or Lung Carcinoma

18. Spinal Canal Tumors Tumors of the Vertebral Canal May Be Benign or Malignant. Spinal Canal Tumors Are Usually Classified As: Extradural (Outside the Meninges) or Intradural (Inside the Meninges). Intradural Tumors My Be Extramedullary (Not Intrinsically Involving the Spinal Cord) or Intramedullary (Intrinsically Involving the Spinal Cord).

19. Spinal Canal Tumors All but Intramedullary Tumors Have the Same Features of Root Involvement and Positive Intrathecal Signs. Compression Causes Radicular Pain As Well As Loss of Neurologic Function Below the Level of the Lesion, Including Progressive Spastic Paraparesis, Paresthesias, and Bladder And/or Bowel Involvement. With Intramedullary Tumors, Sensation Is Lost Early (Especially Pain and Temperature), and Intrathecal Tests Are Often Negative.

20. Spinal Canal Tumors Extradural Carcinomas and Sarcomas From Metastasis or Adjacent Vertebrae; As Well As Lipomas, Fibromas, Neurinomas, Chondromas, Angiomas and Hematomas Also Occur. Intradural Extramedullary Usually Benign Tumors Arising From the Pia or Arachnoid Mater, or From Nerve Root Sheaths. Neurinomas, Meningiomas and Rarely, Sarcomas Have Been Described. Intramedullary Ependymomas Commonly, Hemangiomas and Lipomas Rarely.

21. Spinal Canal Tumors NOTE: Bilateral or Unilateral Radicular Pain at the Site of the Lesion And/or Paresthesias Are Common Findings. Intrathecal Tests Are Usually Positive. Check Associated Cord Function BELOW the Level of the Lesion. Check Carefully for Signs of Bowel or Especially Bladder Dysfunction (Incontinence, Dribbling, Ect.,)