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The symptoms of a brain tumor vary and often are similar
to those of other neurological conditions. Neurological
examinations, imaging studies, laboratory tests, and pathology
reports are all tools physicians use to determine whether
a brain tumor is present, and if there is one, its specific
type. Headache, even when severe, is not necessarily
symptomatic of a brain tumor. However, headache that
is accompanied by loss of balance; nausea and vomiting;
double vision; or numbness may indicate the presence
of a brain tumor. Also of concern is the steady headache
that is worse in the morning than in the afternoon.
Some people with brain tumors experience seizures,
hearing or vision loss, reduced movement in the limbs,
and speech difficulty. Sometimes a stroke can be due
to a brain tumor. Women of child-bearing age may find
that their monthly periods have stopped, although they
are not pregnant. Significantly, not all of the symptoms
of a brain tumor are physical; they can also include
a change in behavior, memory loss, and an inability
to concentrate or reason.
Because these symptoms are shared with many conditions
other than brain tumor, it’s imperative that medical
care be sought for an accurate diagnosis. A neurological
exam typically assesses a patient’s vision and eye movement;
reflexes; coordination and balance; sensory abilities,
such as smell and touch; and mental aptitudes for memory
and abstract thinking.
Following the exam, the doctor may order other
tests, such as:
- Computed Tomography
(CT): By using
this combination of a sophisticated X-ray device and
a computer, the brain’s structure and tissues can
be imaged. A contrast material–iodine dye–may be injected
into the patient during the scan, making it easier
to detect the tumor’s location and other abnormalities.
The Brain Tumor Program at University Hospital uses
a state-of-the-art scanner, the General Electric LightSpeed®;
QX/i, to produce images with unprecedented speed and
image clarity. The LightSpeed can capture multiple
images about six times faster than traditional scanners.
The state-of-the-art scanner also gathers 16 times
more anatomical information in a single scan than
other CT units and produces sharp, detailed images.
- Magnetic Resonance Imaging
(MRI): This equipment uses a magnetic
field rather than radiation to capture an image. By
scanning at different angles, it can provide a 3-dimensional
image of the brain. Contrast material is also often
used. There are different types of MRI techniques:
Intraoperative MRI utilizes images obtained
during surgery. These images provide the surgical
team with a navigation route that adjusts for brain
shift during the procedure. Furthermore, it provides
the surgeon with the opportunity to safely expand
the operative area if necessary for maximum lesion
removal.
Functional MRI (fMRI) is used for pre-operative
brain mapping and surgical planning to assist the
surgeon in avoiding vital areas of the brain. Patients
perform various functions while the MRI is scanning,
so that the patient-specific functional areas of the
brain can be clearly identified on the image.
A flow-sensitive MRI can show how cerebral
spinal fluid (CSF)is traveling through ventricles–small
cavities in the brain that hold CSF–and the spinal
cord. This technique combines images of CSF flow with
functional MRI.
MRI techniques cannot be used with patients who
have pacemakers or other devices that could be affected
by the magnetic fields.
- SPECT: Single
Photon Emission Computed Tomography, or SPECT, is
a scanner that measures a low-dose radioactive material
as it circulates through the brain. SPECT can be used
to differentiate between low and high grade tumors.
For some patients, other tests may be ordered:
X-rays of the skull
may be used to show if any bony erosion or calcification
are occurring; cerebral angiography
takes X-rays of the brain’s blood vessels and may
show the tumor’s position; and an electroencephalogram
(EEG) records electrical activity in the brain.
Laboratory tests can provide useful information
in the diagnosis of brain tumors. A lumbar puncture,
or spinal tap, draws out cerebral spinal fluid. The
fluid is examined for tumor cells, markers, infection,
or blood. A blood sample can be assessed for hormone
levels, which may be affected by the presence of a pituitary
tumor.
Ultimately, a biopsy can provide a specific diagnosis.
When stereotactic equipment is used for biopsy, a computer
guides the needle to the precise tumor site. A small
sample of the tumor is taken and sent to a pathologist
for examination.
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