Low-Grade Astrocytoma Clinical Presentation
- Author: George I Jallo, MD; Chief Editor: Tarakad S Ramachandran, MBBS, MBA, MPH, FAAN, FACP, FAHA, FRCP, FRCPC, FRS, LRCP, MRCP, MRCS more...
No historical factors are pathognomonic for low-grade glioma. The history, however, should alert the clinician to the presence of a neurologic disorder and the need for an imaging study. Characteristically, low-grade gliomas present with headache and most notably seizures. The latter can be present in up to 80% of patients. Other symptoms related to low-grade gliomas are those secondary to the mass effect of the lesion on the surrounding brain parenchyma (i.e hemiparesis, sensory deficits, alterations in speech or visual field defects).
A small percentage of low-grade astrocytomas present in the spinal cord of both children and adults. The history is characterized by a slow onset of back pain and neurologic deficits. The pain usually is localized over the region of the tumor, which is most common in the cervicothoracic area. Neurologic symptoms include paresthesias in the arms or legs. Weakness, objective numbness, and bowel or bladder symptoms also may be present.
A comprehensive neurological exam must me done in any patient who is suspected of harboring an intracranial lesion. The level of conciousness must be assessed and recorded using the Glasgow Coma Scale which has been extensively validated as a reliable method to evaluate the neurological status of patients amongst the different members of the treating personnel (nurses, paramedics, physicians). Cranial nerve deficits are not pathognomonic of low-grade gliomas but the presence of multiple cranial neuropathies is common with brainstem lesions. The motor and sensory exam may disclose hemiparesis as well as hemisensory deficits, increased deep tendon reflexes and signs of corticospinal tract involvement (Babinski sign). In patients with posterior fossa lesions (which are more common in children), signs of cerebellar involvement like ataxia, intention tremor and dysdiadochokinesia are common.
Preoperative neuropsychological assessment may be indicated in patients with a lesion close to or in an eloquent region. Eloquent regions are brain regions that control speech, motor functions, visual perception, and higher cortical functions.
The etiology of low-grade gliomas is poorly understood. There are numerous studies published throughout the literature that have attempted to link specific environmental factors with the subsequent development of brain tumors. Although many potential associations have derived from these studies the only clear predisposing factor is prior exposure to ionizing radiation. Other factors like socioeconomic status, occupational exposure and the ingestion of certain types of foods (those containing a high concentration of N- nitroso compounds) have not shown conclusively that they could be linked to an increase in the development of gliomas.
Definitive genetic associations have been made between conditions like neurofibromatosis (NF-1 and NF-2), tuberous sclerosis, Li-Fraumeni syndrome and Turcot syndrome with the development of gliomas.
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