The document discusses several types of central nervous system (CNS) tumors including gliomas, meningiomas, and pilocytic astrocytomas. Key points include: - Gliomas are the most common CNS tumors in adults and children arising from glial cells. Astrocytomas including glioblastoma multiforme are the most common gliomas. - Meningiomas arise from arachnoid granulation cells and are typically benign, slow growing tumors attached to the dura. - Pilocytic astrocytomas are a type of low-grade glioma that predominantly affects children and presents as a cystic mass with a mural nodule, often

1. CNS Tumors
CPC-44: 22y Sam G, Seizure.
 Mr. SG, 22y, previously healthy male.
 On bus, became agitated, combative, had a
seizure and became unresponsive.
 From Boston, USA, on holidays, 3 days.
 No H/O neck stiffness, no skin lesions/rash
 Pupils minimally reactive and 6mm bilaterally;
fundoscopy normal.

2. CNS Tumors
CPC-4.3.7 – Jenna 27y teacher.
 Jenna is a 27 year old teacher in Ingham who
collapsed in her classroom today. She was
seen by her pupils to „shake all over‟.
 Brought to ED by paramedics, accompanied by
teaching colleague. Collapsed approx 30 mins
ago.
 Tutors: ..look at a broad range of differential
diagnoses for a witnessed, generalized tonic-
clonic seizure. Focus… on epilepsy, infection
(meningitis), and brain tumour.
 ..discuss „what if‟ questions..

3. CNS Tumors
CPC-44: 22y Sam G, Seizure.
 Epileptic seizure
 CVA, CNS Injury, infection, tumour & Epilepsy*
 Drugs: drug withdrawal/ overdose
 Idiopathic (epilepsy), Genetic, Autoimmune,
endocrine..
 Metabolic: uraemia, Hypoglycaemia,
 Neurodegenerative diseases e.g. Alzheimer‟s
 Non epileptic:
 Syncope* - vasovagal
 Arrhythmias, Pseudoseizures (psychogenic),
 Concussion, TIA

4. CNS Tumors
Scenario: Brain Tumor
 Chronic Crescendo Morning - Head ache*
 Pulse 62 bpm reg small volume; BP 140/90 mmHg
T37.4C. GCS - variable.
 Localising signs – seizures, aphasia, anosmia,
vision defects, paralysis (unilateral), dementia.
 Cushing‟s reflex – Bradycardia+hypertension (ICP)
 Papilloedema * raised ICP
 Lesion on imaging.
 Peritumoral edema – rapidly growing/inflammed.
Cresc. Chron. Morn. headache*, Seizures, localizing signs

5. CNS Tumors
Scenario: Meningitis
 ABC breathing spontaneously rr 18/min 4l O2 via
mask, sats 90%; pulse 110 bpm reg small volume;
BP 90/60 mmHg T39.6C
 GCS - E2V3M4
 Detailed check - petechiae non blanching rash
trunk, buttocks, Neck stiffness
 Small contusion L temperoparietal area
 Capillary refill time > 3 secs, peripheral cyanosis+
 Brudzinski sign positive
 Ix skin scraping from lesion : gram negative
diplococci; CSF gram negative diplococci; FBC wcc
18 (polymorhic leucocytosis)
Brudzinski sign, Kernig sign, CSF findings

6. CNS Tumors
Scenario: Epilepsy:
 ABC breathing spontaneously rr 14/min; 4l O2 via
mask , sats (O2 Sat study) 96% ; pulse 100 bpm regular
good volume T 36.1 C BP 148/94.
 GCS E2V3M4
 Detailed check no neck stiffness, no skin lesions/rash
 Tongue has been bitten; pupils equal and reactive to
light; fundoscopy normal
 Decreased tone R upper limb, ?normal tone other limbs
 Reflexes increased on R upper + lower limb; decreased
on L upper +lower;
 Plantar reflexes upgoing
 Evidence of urinary incontinence
 All other systems : nil abnormal
 Ix - BSL : 5.1; toxicology screen : negative
Negative signs, family / past history

7. CNS Tumors
Core Learning Issues:
 Pathology Major CLI:
 Raised ICP – Pathology & Clinical features.
 Pathology of common CNS tumors in different age
groups.
 Astrocytoma – grades, clinical types, presentation &
complications. – “glioblastoma multiforme”
 Meningitis – common types *Bacterial – Micro-Lec*.
 Pathology Minor CLI:
 Pathology of Epilepsy (note this is major clinical
learning issue)
 Meningioma, Acoustic neuroma, Craniopharyngioma /
pituitary tumors. Medulloblastoma.
 CJD-Creutzfeldt jakob's disease. (Mad cow disease).

8. In every person who comes near you
look for what is good and strong;
honor that; try to learn it, and your
faults will drop off like dead leaves
when their time comes.
--John Ruskin
Look for good in others “No one is without faults and
everyone has good qualities…!”

9. Pathology of
CNS Tumors
Dr. Venkatesh M. Shashidhar, MD
Associate Professor & Head of Pathology

10. CNS Tumors
CNS Tumors: General Features
 10% of all tumors. (10 to 17 per 100,000)
 Commonest solid cancers in children.(2nd to Leuk)
 Age: double peak 1st & 6th decade
 Adults - 70% supratentorial
 Children - 70% infratentorial
 Metastatic tumors are
the most common (50-70%)
 Primary - glial origin.
 Very rare extraneural
spread.
 Location & not nature determines
prognosis.

11. CNS Tumors
Most common CNS Tumors:
Adults
children

12. CNS Tumors
CNS Tumors Classification:
Secondary Tumors - Metastasis – commonest
>50%* breast, lung, GIT, Melanoma.
Primary Tumors: (not from neurons…!)
Glial cells: Glioma * commonest
Astrocytoma (& Glioblastoma). Oligodendroma,
ependymoma.
Nerve sheath – Schwanoma, Neurofibroma.
Meninges: Meningioma
Germ cell: Medulloblastoma, neuroblastoma,
teratoma, neuroma, neuroganglioma.
Lymphocytes: CNS Lymphoma
* Other BV: (angioma)Epithelial, Pituitary & Pineal
gland tumors.

13. CNS Tumors
Clinical features:
 Slow, Progressive..*
 Crescendo, Chronic, Morning head ache.
 Local damage:
 Nerve & tract deficits, unilateral*
Paralysis, vision defects, anosmia,
seizures.. etc.
 Raised Intracranial Pressure*
 Headache, vomiting, slow pulse,
papilloedema.

14. CNS Tumors
CNS Tum: Clinical Features-Pathogenesis
 Headaches (morning)  Increased ICP
 Papilloedema  Increased ICP
 Nausea or vomiting  ICP – Medulla ob.
 Bradycardia  ICP – Parasymp.
 Seizures (convulsions).  Irritation.
 Drowsiness, Obtundation  Brain Stem compress
 Personality or memory  Frontal lobe
 Changes in speech  Temporal lobe
 Limb weakness  Motor area
 Balance/Stumbling  Cerebellum
 eye movements or vision  Optic tract, occipital.

15. CNS Tumors
CNS functional anatomy – localizing signs

16. CNS Tumors
Common:
 Adults:
 Astrocytoma & (Metastases)
Glioblastoma.
 Meningioma
 Metastasis.
 Children:
 Astrocytoma
 Medulloblastoma

17. CNS Tumors
Meningioma:
 Arachnoid granulation fibroblasts
venous sinuses (Attached to
dura).
 Females(2:1), progesterone,
cyclical/preg*
 Common site: parasagittal (falx),
 Slow growth, well differentiated &
demarcated. Does not invade
brain (Benign).
 Reactive skull Hyperostosis over
the tumor.

18. CNS Tumors
Meningioma:
Note location in the venus sinus & adherent to dura.

19. CNS Tumors
Meningioma: multiple

20. CNS Tumors
Meningioma
Tumor
MCAQ
Pituitary

21. CNS Tumors
Meningioma

22. CNS Tumors
Meningioma high grade: (rare)

23. CNS Tumors
Meningioma Nodules
Capsulated,
spindle cells in whorls
and psammoma bodies
(common type).

24. Psammoma bodies
(calcification)

25. CNS Tumors
Glioma:
 Gliomas are neoplasms of glial cells.
 Commonest both in adults and
children.
 Benign * to Aggressively malignant.
 Astrocytoma (low & high grade)
 Ependymoma - Rare, 4th ventricle.
 Oligodendroglioma - Benign, adults,
rare

26. CNS Tumors
Astrocytomas - Glioma
 Adults:
 Commonest 80%, Cerebral.
 Low Gr: Solid, Fibrillary glioma
 High Gr: glioblastoma multiforme Varigated,
Hemorrhagic - Malignant,.
 Children:
 Cystic, Low grade*, Pilocytic
 Infratentorial (Cerebellum),
mutations of the metabolic enzyme Isocitrate DeHydrogenase (IDH1 and IDH2) are
common in lower-grade astrocytomas. As a result, immunostaining for the mutated
form of IDH1 has become an important diagnostic tool for low grade gliomas.

27. CNS Tumors
Astrocytoma-Lowgrade fibrillary

28. CNS Tumors
Astrocytoma

29. CNS Tumors
Glioma Brain Stem – note diffuse tumor

30. CNS Tumors
Glioma Cerebrum cystic degeneration

31. CNS Tumors
Glioma:

32. CNS Tumors
Astrocytoma: * Lat. Vent. *petechial hem.

33. CNS Tumors
Astrocytoma (Glioma) – brain stem

34. CNS Tumors
Glioma Brain Normal

35. CNS Tumors
Astrocytomas
 Adults:
 Commonest 80%, Cerebral.
 Low Gr: Solid, Fibrillary.
 High Gr: glioblastoma multiforme
Varigated, Hemorrhagic - Malignant,.
 Children:
 Cystic, Low grade*, Pilocytic
 Infratentorial (Cerebellum),

36. CNS Tumors
Glioblastoma Multiforme (GBM):
 High grade Astrocytoma - Grade IV
 Commonest & malignant brain tumor in adults –
mean survival <1y – cerebral supratentorial.
 Loss of heterozygosity on Chromosome 10 (80%)
 Most GBMs have lost one entire copy of C – 10
 2 types: Primary (worst) or Secondary from low grade
astrocytomas (better prog).
 Variants: giant cell GBM, gliosarcoma
 Microscopy:
 Necrosis, palisading, hypercellularity, nuclear atypia
& vascular proliferation & mitoses.

37. CNS Tumors
Genetic abnormalities in Glioma:
Low grade  Anaplastic  GBM
* GBM can occur alone without prior glioma
In glioblastoma, loss-of-function mutations in the p53 and Rb tumor suppressor
pathways and gain-of-function mutations in the oncogenic PI3K pathways have
central roles in tumorigenesis.

38. CNS Tumors
Glioma: high grade

39. CNS Tumors
GBM: MRI
Enhancement
with
peritumoral
edema.

40. CNS Tumors
Glioblastoma – high grade Astrocytoma

41. CNS Tumors
Glioblastoma – high grade Astrocytoma
Note: Looks like abscess, but it is necrosis..!

42. CNS Tumors
Glioblastoma Multiforme (high grade Astrocytoma)

43. CNS Tumors
Glioblastoma Cerebrum

44. CNS Tumors
High Gr.: Glioblastoma multiforme
(high grade- Hypercellularity, necrosis, hemorrhage & palisading)
Hyper cel. Hem
Necro

45. CNS Tumors
Glioblastoma Multiforme
Necrosis
Palisading

46. CNS Tumors
Glioblastoma Multiforme

47. A Astrocytoma Low grade
B Glioblastoma Multiforme(GBM)
C Necrosis with
pseudopalisading in GBM.

48. CNS Tumors
Astrocytomas
 Adults:
 Commonest 80%, Cerebral.
 Low Gr: Solid, Fibrillary.
 High Gr: glioblastoma multiforme
Varigated, Hemorrhagic - Malignant,.
 Children:
 Cystic, Low grade*, Pilocytic Astrocytoma
 Infratentorial (Cerebellum),

49. CNS Tumors
Pilocytic astrocytoma
 Children, slowest
growth,
 Cerebellum,
 Cystic with mural
nodule
 Micro: elongated
hair-like (pilocytic)
cells
Mutations in IDH1 and IDH2 (common in low-grade diffuse astrocytomas) are not
found in pilocytic tumors. These genetic distinctions support the division of these
astrocytomas into two diagnostic categories.

50. CNS Tumors
Pilocytic Astrocytoma - children

51. CNS Tumors
Pilocytic Astrocytoma:
solid, brightly contrast-enhancing mural component and associated cyst.

52. CNS Tumors
Pilocytic Astrocytoma: Microscopy
Palisading pilocytic astrocytes – note plenty of Rosenthal fibres between cells.

53. CNS Tumors
Medulloblastoma:
 Children.
 Cerebellum – vermis.
 Primitive neuroectodermal tum.
 Blast cells – round scanty cytoplasm.
 4th ventricle Obstruction – hydrocephalus.
 CSF seeding and Meningeal infiltration is
common.
 Rosettes & neuronal or glial differentiation
rarely seen.

54. CNS Tumors
Medulloblastoma:
Primitive neuroectodermal tumor:
Children, vermis of cerebellum.
Spread
Origin

55. CNS Tumors
Medulloblastoma

56. CNS Tumors
Medulloblastoma

57. CNS Tumors
Youtube Videos:
 Glioblastoma Multiforme:
 http://www.youtube.com/watch?v=idSos1XOi7A
 http://www.youtube.com/watch?v=bGawC2RJ-Sc
 Meningioma:
 http://www.youtube.com/watch?v=ddEB5ITx2fw
 Pyogenic Meningitis:
 http://www.youtube.com/watch?v=L9jpjxTSLws

58. CNS Tumors
CNS Lymphoma:
 Rare, 1%, most common
CNS neoplasm in
immunosuppressed
(transplant recipients,
AIDS), caused by Epstein-
Barr Virus.
 High grade, large B-cell
lymphomas. Poor
response to chemotherapy

59. CNS Tumors: Summary
Adults:
 Secondary common
 Lung, Skin, breast..
 Primary - Supratentorial
 Astrocytoma /
glioblastoma.
 Meningioma
Children:
 2nd common (leuk / lymph)
 Infratentorial
 Astrocytoma (cystic
cerebellar)
 Medulloblastoma
 Hydrocephalus.
 Meningeal spread.

60. CNS Tumors
AV Malformation:

61. Pathology of
Increased Intracranial
Pressure.

62. CNS Tumors
Increased ICP: Pathogenesis & Clinical.
 Increased intracranial pressure (ICP):
 Ischemia, Hematoma, Infection, tumor,
 >40 mm Hg  cerebral hypoxia, ischemia, edema
 Cerebral edema: Vasogenic – inflammation/tumors or Cytotoxic
hypoxic, toxins.
 Clinical Features:
 Headache + impaired consciousness,
 Vomiting, bradycardia, arterial hypertension
 Papilloedema.
 False localizing signs:
 Ipsilateral pupillary dilatation & Hemiparesis.
 6th nerve lesion uni or bilateral.
 Bilateral extensor plantar response (+ve Babinski)

63. CNS Tumors
Pathogenesis of complications:
 Cerebral herniation: Supratentorial herniation
common. 3 sub types
 Subfalcine herniation: The cingulate gyrus of the frontal
lobe (commonest)
 Central transtentorial herniation: displacement of the
basal nuclei and cerebral hemispheres downward
 Uncal herniation: Medial edge of the uncus and the
hippocampal gyrus
 Cerebellar herniation: infratentorial herniation
 Tonsil of the cerebellum is pushed through the foramen
magnum and compresses the medulla, leading to
bradycardia and respiratory arrest.

64. CNS Tumors
Common CNS Herniations:
 Subfalcine: common,
Headache contralateral
leg weakness.
 Transtentorial:
occulomotor (CN III)
paresis (ipsilateral
dilated pupil, abnormal
EOM's), contralateral
hemiparesion.
 Tonsillar: Obtundation.

65. CNS Tumors
Subfalcine Herniation: in brain trauma.
Contusion of the inferior temporal
lobe (blue arrow) has resulted in
diffuse edema. (compressed and
flattened gyri on the right).
This has resulted in subfalcine
herniation of the cingulate gyrus
(red arrow), with a secondary
hemorrhagic infarction above that
(black arrow). A midline shift from
right to left is also present, as is
uncal herniation (yellow arrow).

66. CNS Tumors
acute brain swelling + Uncal Herniation
 Swelling of the left
cerebral hemisphere
has produced a shift
with herniation of the
uncus of the
hippocampus through
the tentorium, leading
to the groove seen at
the white arrow.

67. CNS Tumors
Herniation: Central Pontine / Duret Hem.

68. CNS Tumors
Cerebellar Tonsil - Herniation
 Note the cone shape of the
herniated tonsils around the
medulla in this cerebellum
specimen.
 Results in compression and
Duret hemorrhages in the
pons.

69. CNS Tumors
Cerebral Herniation: Pathogenesis
Site of
herniation Effect Clinical consequence
Transtentorial Ipsilateral 3rd cranial nerve Ipsilateral fixed dilated pupil
compression
Ipsilateral 6th cranial nerve Horizontal diplopia, convergent
compression squint
Posterior cerebral artery Occipital infarction Cortical blindness
compression
Cerebral peduncle Upper motor neurone signs
compression
Brainstem compression and Decerebrate posture
haemorrhage Cardiorespiratory failure
Death
Foramen Brainstem compression and Decerebrate posture
magnum haemorrhage Cardiorespiratory failure Death
Acute obstruction of CSF Decerebrate posture elbows,
Decorticate posturing: The
pathway Cardiorespiratory failure
wrists and fingers flexed, legs
Death and rotated inward.
extended

70. CNS Tumors
Why pupils dilate?
“Sympathetic system shows sympathy to your pants”

71. CNS Tumors
CPC-3.7– KFP Questions:
 Meningitis Types, classification & comparison.
 Septic, Viral & TB meningitis - CSF findings.
 Increased intracranial pressure – Pathologic
basis of clinical features.
 CNS tumours: common features.
 Adult and childhood CNS tumors.
 Meningioma, astrocytoma & Glioblastoma.
 Children astrocytoma & medulloblastoma.
 Epilepsy – clinical.

72. CNS Tumors
Learning Medicine...!
 Learning medicine should be a JOY, not an ordeal.
 Everyone learns according to their own best style.
 The Hippocratic oath issues of patient privacy,
compassion, and FREE sharing of knowledge have to
be honored.
 Exam and grade anxieties are the CANCERS of
medical education.
 If your school admitted students which they feel need to
be whipped, the SCHOOL has failed, not YOU!
 If you claim you NEED to be pushed, I do not want you
as my doctor.
John R. Minarcik, MD (http://www.medicalschoolpathology.com)

73. It has been my philosophy of
life that difficulties vanish
when faced boldly.
--Isaac Asimov

74. CNS Tumors
SAQ / KFP
 Should seizure patients have
imaging done immediately?  Yes, 10-20% tumors.
 Personality changes indicate  Frontal lobe
which location?
 Differentials for young adult  Other gliomas
with insidious symptoms,
seizures and decreased signal
on T1 and increased signal on
 Conservative – Poor
T2 weighted MRI?
 Steroids, anti
 What is the treatment and
prognosis for someone with a epileptic,
low-grade astrocytoma?
 How should the symptoms be symptomatic.
treated?
 What tests could have been
 EEG
done in the absence of
neuroimaging?

75. CNS Tumors
SAQ / KFP
 Why was the child hitting his  Indicating headache.
head?
 Why did the child have a  Increased ICP, tum.
headache?
 4th ventricle.
 If the child does have
hydrocephalus, at what level  No – coning…*
is the ventricular system
being obstructed at?  Central – vermis
 Should a lumbar puncture be  Separation/malfusion of
performed?
 Where in the cerebellum is anterior frontoparietal
the lesion located? suture due to
 What is the radiolucent area hydrocephalus.
visible along the antero-
superior aspect of the
radiograph?

76. CNS Tumors
SAQ / KFP
 Name the location of  Cerebellopontine angle
tumor?  Cranial Nerves 5,7 & 8
 What cranial nerves  Teratoma, meningioma,
are involved? acoustic neuroma.
 List differential  Increased intracranial
diagnosis tension.
 Explain pathogenesis  Tumor attempting to form
of headache and Arachnoid grannulations.
papilledema? Origin of tumor.
 What does
the histological pattern
represent in slide 1?
slide 2?

77. CNS Tumors
50y Female smoker - Headache.
This 50 year-old female smoker known for hypertension
and diabetes mellitus type 2 was in her usual state of
health until 2 years ago, when she began to have
morning headaches that would usually go away by
themselves. Year later began to have hearing problem
on her left side. Recently, she noticed intermittent loss
of sensation of the left side of her face. She is taking a
thiazide diuretic, captopril, glyburide, and metformin.
She has no known allergies.
Physical exam: Slight drooping in the left mouth and
lower eyelid. Incomplete closure of the left eyelid with
corneal touch. Reduced pain and light touch on the left
side. Fundoscopic exam revealed bilateral papilledema.

78. CNS Tumors
35y Male, depression
2-year history of loss of initiative, depression. He had
slowly lost his drive to win all the big deals he always
done so well at work. 3 months ago he began to
experience headache, which did not respond to
acetaminophen or aspirin. His wife noticed that his
lethargic state had increased in the past few months. 3
days ago his right arm began to convulse uncontrollably
for 1 minute. 1 day ago the patient began again violently
shaking his right arm, and the right side of face began to
twitch at the dinner table. No fever.
Physical exam: Bilateral papilledema, increased deep
tendon reflexes of the right bicep, tricep, +ve babinski
sign on the right foot, reduced leg strength on the right.

79. CNS Tumors
35y Male, depression
Axial T2 weighted MRI
Axial T1 weighted MRI

80. CNS Tumors
35y Male, depression
Coronal T2 weighted MRI
Coronal T1 weighted MRI

81. CNS Tumors
3y Male, constant cry….
Constant crying and not interacting with other
children at daycare since 1m. Mother noticed
that he was pointing to his head often. Family
physician who stated that he was developing
normally, and that the “ terrible two‟s” are difficult
period for parents. Recently started vomiting on
a daily basis and started wobbling even though
he learned to walk 6 months ago.
Physical: Bilateral papilledema and gait ataxia
was noted on the physical exam.

82. CNS Tumors
3y Male, constant cry….
Axial T1 weighted MRI Axial T2 weighted MRI

83. CNS Tumors
3y Male, constant cry….
Coronal T1 weighted MRI

84. CNS Tumors
What is the most likely diagnosis?
1. Glioblastoma m.
2. Astrocytoma
3. Meningioma
4. Ependymoma
5. Medulloblastoma

85. CNS Tumors
65y Fem morning headache.
Morning headache 2y, Progressive right upper limb
weakness. She woke up this morning obtunded, and did
not initially respond to her husband‟s cries. She
screamed to her husband that she could not see
anything to her right, and that she that her left arm and
leg were very weak. At this point her husband rushed
her to the nearest hospital.
Physical Exam: left lid ptosis, left-pupillary dilation, and
failure of her left eye to constrict to light directly or
consenually. Patient had bilateral lower limb weakness,
with increased deep tendon reflexes on the left side,
and a +ve babinski on the left side. Bilateral
Papilledema. Homonymous hemianopia of the right
side. Visual acuity was corrected to 20/20 with glasses.

86. CNS Tumors
65y Fem morning headache.

87. CNS Tumors
Brain Metastasis:
 Lung, Breast, Skin,
Kidney, GIT.
 Prostate – never..!
 Well demarcated,
usually multiple with
surrounding rim of
inflammation.
 Carcinomatosis:
Meningeal CSF spread
of malignant cells.

88. CNS Tumors
Metastatic Melanoma: multiple

89. CNS Tumors
Brain Metastases: Surrounding edema.

90. CNS Tumors
What is the most likely diagnosis?
1. Glioblastoma m.
2. Astrocytoma
3. Meningioma
4. Ependymoma
5. Medulloblastoma

91. CNS Tumors
SAQ / KFP
 Are there clinical signs of  Yes, ptosis, pupils 3rd
nerve compression?
 What is the most likely cause  Optic pathway -
of the homonymous occipital.
hemianopia?
 Why does the patient have  Motor cortex
progressive right upper limb compression – tum.
weakness, and paroxysmal
left upper and lower limb  Risky.
weakness?
 Should a lumbar puncture be  Brainstem
performed? compression.
 Why was the patient
obtunded?  Meningioma
 Why was an-x-ray taken? hyperostosis.

92. Other CNS
tumors

93. CNS Tumors
Nerve Sheath Tumors:
 Neurofibroma:
 Epi & endoneurial fibroblasts.
 Form whorls of fibroblasts with nerves
 Well differentiated, benign, capsulated.
 Schwannoma:
 Schwann cells, elongated form whorls
 Nuclear palisading

94. CNS Tumors
Schwannoma / Neurofibroma

95. CNS Tumors
Schwannoma 8th Nerve:

96. CNS Tumors
Bilateral 8th nerve schwannomas.

97. CNS Tumors
Schwannoma:

98. Neurofibromatosis:
Café-au-lait spot

99. Neurofibromatosis:

100. CNS Tumors
Schwannoma

101. CNS Tumors
A 26-year old female
Headache,vomiting, an
epileptic attack, weakness
of legs. Now drowsy. Two
weeks before admission
she gave her second birth.
CT and NMR revealed a
huge parasagittal tumor
(80x67x65 mm), enhanced
by contrast, compressed
corpus callosum and
ventricles.

102. CNS Tumors
7th nerve palsy:
 Cerebellopontine angle
tumours.
 Acoustic neuroma,
 epidermoid cysts,
 medulloblastoma
 meningioma
 Affected cranial nerves:
 5 trigeminal - masticatio
 7 facial –face muscles
 8 auditory – hearing

103. CNS Tumors
Brudzinski Sign of Meningitis: