4 Hospital Physician Board Review Manual www.turner-white.com
ing and repetition are impaired. Motor examination
reveals significant weakness in his right hand.
Deep tendon reflexes are more brisk on the entire
right side. The right plantar response is upgoing.
Coordination testing on the right side is hampered
by weakness, but is intact on the left side. The re-
mainder of the examination is unremarkable.
a brain tumor?
CLINICAL FEATURES OF BRAIN TUMORS
Symptoms from a brain tumor can be focal
or generalized. The most common presenting
symptoms in patients with brain tumor include
headaches, seizures, cognitive impairment, per-
sonality changes, and focal neurological defi-
cits. Focal signs and symptoms reflect the lo-
cation of the tumor within the central nervous
Headache is a presenting symptom in approximately 48% of newly diagnosed brain tumors. 6 It
is often dull, non-throbbing, and intermittent. Supratentorial masses can result in frontal headache.
Posterior fossa masses cause headache in occipital and cervical areas. Early morning headache
is considered a classic presentation because of
increased intracranial pressure (ICP) in the recumbent position. However, this classic presentation
occurs in a minority of patients. 6
Seizures are the presenting feature of brain
tumors in approximately one-third of cases. They
occur due to irritation of the brain parenchyma.
There is evidence that blood–brain-barrier failure
may be an etiological factor contributing to the development of seizures. 7
Low-grade tumors, particularly oligodendroglio-
mas, have a relatively greater tendency to present
with seizures (over 70% in some series). 8, 9 Even
if seizures do not occur at presentation, they may
Table 1. Genetic Syndromes Associated with Nervous System Tumors (continued)
Cowden Dysplastic ganglio-
cytoma of the cer-
Oral mucosa fi-
10q23 PTEN PTEN Tumor suppressor
causes cell cycle ar-
rest and apoptosis,
polyps or carci-
sor gene regulating
and plantar pits
9q22 PTCH1 Ptc1 Tumor suppressor,
APC = adenomatous polyposis coli; hMLH1 = human MutL homolog; hPMS2 = human postmeiotic segregation increased 2; MPNST =
malignant peripheral nerve sheath tumor; m TOR = mammalian target of rapamycin; PI3K = phosphoinositide-3-kinase, PTCH = Drosophila
patched homolog 1; PTEN = phosphatase and tensin homolog.