Transient Global Amnesia Late middle age Anterograde and retrograde amnesia

1. Transient Global Amnesia • Late middle age • Anterograde and retrograde amnesia • Resolves within 24-48 hours • Recurrences in 20% of patients • Postulated causes: migraine, temporal lobe seizures, and TIA in the posterior cerebrum Hauser, S, et al (2006) Harrison’s Neurology in Clinical Medicine. USA: McGraw Hill.

2. Tension • Migraine • Cluster

3. Headache symptoms that suggest a serious underlying disorder • “Worst” headache ever • First severe headache • Subacute worsening over days or weeks • Abnormal neurologic examination • Fever or unexplained systemic signs • Vomiting precedes headache • Induced by bending, lifting, cough • Disturbs sleep or presents immediately upon awakening • Known systemic illness • Onset after age 55 Hauser, S, et al (2006) Harrison’s Neurology in Clinical Medicine. USA: McGraw Hill.

4. Symptoms of Serious Underlying Cause of Headache Hauser, S, et al (2006) Harrison’s Neurology in Clinical Medicine. USA: McGraw Hill.

6. Approach to a patient with Brain tumor Hauser, S, et al (2006) Harrison’s Neurology in Clinical Medicine. USA: McGraw Hill.

7. Ropper, A, et al (2005) Adams and Victor’s Principles of Neurology. USA: McGraw Hill.

8. Modes of Clinical Presentation • Patients who present with focal cerebral signs and general impairment of cerebral function, headaches, or seizures • Patients who present with evidence of increased intracranial pressure • Patients who present with specific intracranial tumor syndromes Ropper, A, et al (2005) Adams and Victor’s Principles of Neurology. USA: McGraw Hill.

9. Patients who present with focal cerebral signs and general impairment of cerebral function, headaches, or seizures • Astrocytoma (Well- differentiated) • Oligodendroglioma • Glioblastomamultiforme and AnaplasticAstrocytoma (High grade gliomas) • Meningioma Ropper, A, et al (2005) Adams and Victor’s Principles of Neurology. USA: McGraw Hill.

10. Astrocytoma (Well- differentiated) • tumor that forms from neoplastic transformation of the supporting cells of the brain, neuroglia. • 20- to 40-y/o age group • Headache or subtle neurobehavioral changes • Seizures can occur and may be either focal or generalized • Very gradual onset Ropper, A, et al (2005). Adams and Victor’s Principles of Neurology. USA: McGraw Hill. Goetz, C. (2003). Textbook of Clinical Neurology. USA: Elsevier http://emedicine.medscape.com/

11. Oligodendroglioma • arise within the cortex and further extend into the white matter of the cerebral hemispheres in rough proportion to the mass of each lobe (frontal, parietal, temporal, and occipital) • 30- to 50-y/o age group • Headache, hydrocephalus, focal neurological findings • Seizures are the most common presenting symptom • Grows very slowly Ropper, A, et al (2005). Adams and Victor’s Principles of Neurology. USA: McGraw Hill. Goetz, C. (2003). Textbook of Clinical Neurology. USA: Elsevier http://emedicine.medscape.com/

12. Glioblastomamultiforme and AnaplasticAstrocytoma (High grade gliomas) • heterogenous mixture of poorly differentiated neoplasticastrocytes, primarily affect adults, and located preferentially in the cerebral hemispheres. • Most arise in the deep white matter and quickly infiltrate the brain extensively • Occurs after 50 yrs old • Clinical history is usually short, less than 3 months in >50% of patients Ropper, A, et al (2005). Adams and Victor’s Principles of Neurology. USA: McGraw Hill. Goetz, C. (2003). Textbook of Clinical Neurology. USA: Elsevier http://emedicine.medscape.com/

13. Glioblastomamultiforme and AnaplasticAstrocytoma (High grade gliomas) • General symptoms are headaches, nausea and vomiting, personality changes, and slowing of cognitive function. • inc. ICP - headaches, nausea and vomiting, and cognitive impairment. • Headaches can vary in intensity and quality, and more severe in the early morning or upon first awakening. • Focal signs include hemiparesis, sensory loss, visual loss, aphasia, and others. • Seizures Ropper, A, et al (2005). Adams and Victor’s Principles of Neurology. USA: McGraw Hill. Goetz, C. (2003). Textbook of Clinical Neurology. USA: Elsevier http://emedicine.medscape.com/

14. Meningioma • arise from arachnoidal cap cells, which reside in the arachnoid layer covering the surface of the brain. • Increase incidence with age, 60- to 70-y/o age group • Benign but may enlarge and cause compression of neural elements and can behave aggressively • Subtle signs and symptoms such as progressive headache, memory loss, or cognitive changes • Seizures • Focal or more generalized cerebral dysfunction, like focal weakness, dysphasia, apathy, and/or somnolence. Ropper, A, et al (2005). Adams and Victor’s Principles of Neurology. USA: McGraw Hill. Goetz, C. (2003). Textbook of Clinical Neurology. USA: Elsevier http://emedicine.medscape.com/

15. Meningioma • Meningiomas in specific locations may give rise to the stereotyped symptoms • Parasagittalfrontoparietalmaningioma may cause a slowly progressive spastic weakness or numbness of one leg and later of both legs, and incontinence in the late stages. Ropper, A, et al (2005). Adams and Victor’s Principles of Neurology. USA: McGraw Hill. Goetz, C. (2003). Textbook of Clinical Neurology. USA: Elsevier http://emedicine.medscape.com/