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脑肿瘤的临床表现和诊断

Authors
Eric T Wong, MD
Julian K Wu, MD
Section Editors
Jay S Loeffler, MD
Patrick Y Wen, MD
Deputy Editor
April F Eichler, MD, MPH
Translators
孙来广, 主任医师

引言

脑肿瘤是指一组不同的肿瘤，这些肿瘤来源于中枢神经系统(central nervous system, CNS)的各种细胞或来源于已转移至CNS的全身性肿瘤。脑肿瘤包括多种组织学类型，这些类型的肿瘤生长速率显著不同(表 1)。 (参见“脑转移瘤患者的临床表现、诊断和治疗概述”)

通过侵袭局部脑组织、压迫临近组织及升高颅内压(intracranial pressure, ICP)，脑肿瘤会产生症状和体征。除了肿瘤的组织学类型，脑肿瘤的临床表现还取决于脑受累部位的功能。对怀疑脑肿瘤的患者进行适合的评估需要详细的病史、全面的神经系统检查和适当的诊断性神经影像学检查[1]。

原发性脑肿瘤的临床表现和诊断将总结在此。各种原发性脑肿瘤的各个方面将在具体的专题中讨论，脑转移瘤的表现、诊断和处理参见其他专题。 (参见“脑转移瘤患者的临床表现、诊断和治疗概述”)

临床表现

原发性或转移性脑肿瘤患者可能表现为全面性或局灶性体征和/或症状(表 2)。

全面性

头痛 — 头痛是脑肿瘤的常见表现，在约一半的患者中是最严重的症状[2]。头痛经常表现为持续性钝痛，但偶尔为跳痛。除非出现梗阻性脑积水或脑膜刺激征，否则严重头痛少见。“典型”的脑肿瘤晨起头痛似乎不多见。 (参见“成人头痛的评估”)

                            

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Literature review current through: 2017-06 . | This topic last updated: 2017-07-19.
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References
Top
  1. Gutin PH, Posner JB. Neuro-oncology: diagnosis and management of cerebral gliomas--past, present, and future. Neurosurgery 2000; 47:1.
  2. Forsyth PA, Posner JB. Headaches in patients with brain tumors: a study of 111 patients. Neurology 1993; 43:1678.
  3. Moots PL, Maciunas RJ, Eisert DR, et al. The course of seizure disorders in patients with malignant gliomas. Arch Neurol 1995; 52:717.
  4. Cohen N, Strauss G, Lew R, et al. Should prophylactic anticonvulsants be administered to patients with newly-diagnosed cerebral metastases? A retrospective analysis. J Clin Oncol 1988; 6:1621.
  5. Pace A, Bove L, Innocenti P, et al. Epilepsy and gliomas: incidence and treatment in 119 patients. J Exp Clin Cancer Res 1998; 17:479.
  6. Lote K, Stenwig AE, Skullerud K, Hirschberg H. Prevalence and prognostic significance of epilepsy in patients with gliomas. Eur J Cancer 1998; 34:98.
  7. FRANKEL SA, GERMAN WJ. Glioblastoma multiforme; review of 219 cases with regard to natural history, pathology, diagnostic methods, and treatment. J Neurosurg 1958; 15:489.
  8. ROTH JG, ELVIDGE AR. Glioblastoma multiforme: a clinical survey. J Neurosurg 1960; 17:736.
  9. Cavaliere R, Farace E, Schiff D. Clinical implications of status epilepticus in patients with neoplasms. Arch Neurol 2006; 63:1746.
  10. Cascino GD. Epilepsy and brain tumors: implications for treatment. Epilepsia 1990; 31 Suppl 3:S37.
  11. Keane JR. Neurologic symptoms mistaken for gastrointestinal disease. Neurology 1998; 50:1189.
  12. Squires RH Jr. Intracranial tumors. Vomiting as a presenting sign. A gastroenterologist's perspective. Clin Pediatr (Phila) 1989; 28:351.
  13. Hayashi M, Handa Y, Kobayashi H, et al. Plateau-wave phenomenon (I). Correlation between the appearance of plateau waves and CSF circulation in patients with intracranial hypertension. Brain 1991; 114 ( Pt 6):2681.
  14. Hayashi M, Kobayashi H, Handa Y, et al. Brain blood volume and blood flow in patients with plateau waves. J Neurosurg 1985; 63:556.
  15. Anderson MD, Colen RR, Tremont-Lukats IW. Imaging mimics of primary malignant tumors of the central nervous system (CNS). Curr Oncol Rep 2014; 16:399.
  16. Scott JN, Brasher PM, Sevick RJ, et al. How often are nonenhancing supratentorial gliomas malignant? A population study. Neurology 2002; 59:947.
  17. Poptani H, Gupta RK, Roy R, et al. Characterization of intracranial mass lesions with in vivo proton MR spectroscopy. AJNR Am J Neuroradiol 1995; 16:1593.
  18. Warren KE, Frank JA, Black JL, et al. Proton magnetic resonance spectroscopic imaging in children with recurrent primary brain tumors. J Clin Oncol 2000; 18:1020.
  19. Burtscher IM, Skagerberg G, Geijer B, et al. Proton MR spectroscopy and preoperative diagnostic accuracy: an evaluation of intracranial mass lesions characterized by stereotactic biopsy findings. AJNR Am J Neuroradiol 2000; 21:84.
  20. Galanaud D, Chinot O, Nicoli F, et al. Use of proton magnetic resonance spectroscopy of the brain to differentiate gliomatosis cerebri from low-grade glioma. J Neurosurg 2003; 98:269.
  21. Pope WB, Prins RM, Albert Thomas M, et al. Non-invasive detection of 2-hydroxyglutarate and other metabolites in IDH1 mutant glioma patients using magnetic resonance spectroscopy. J Neurooncol 2012; 107:197.
  22. Andronesi OC, Kim GS, Gerstner E, et al. Detection of 2-hydroxyglutarate in IDH-mutated glioma patients by in vivo spectral-editing and 2D correlation magnetic resonance spectroscopy. Sci Transl Med 2012; 4:116ra4.
  23. Choi C, Ganji SK, DeBerardinis RJ, et al. 2-hydroxyglutarate detection by magnetic resonance spectroscopy in IDH-mutated patients with gliomas. Nat Med 2012; 18:624.
  24. de la Fuente MI, Young RJ, Rubel J, et al. Integration of 2-hydroxyglutarate-proton magnetic resonance spectroscopy into clinical practice for disease monitoring in isocitrate dehydrogenase-mutant glioma. Neuro Oncol 2016; 18:283.
  25. Quan D, Hackney DB, Pruitt AA, et al. Transient MRI enhancement in a patient with seizures and previously resected glioma: use of MRS. Neurology 1999; 53:211.
  26. Wong ET, Jackson EF, Hess KR, et al. Correlation between dynamic MRI and outcome in patients with malignant gliomas. Neurology 1998; 50:777.
  27. Batchelor TT, Sorensen AG, di Tomaso E, et al. AZD2171, a pan-VEGF receptor tyrosine kinase inhibitor, normalizes tumor vasculature and alleviates edema in glioblastoma patients. Cancer Cell 2007; 11:83.
  28. Alsop DC, Detre JA. Multisection cerebral blood flow MR imaging with continuous arterial spin labeling. Radiology 1998; 208:410.
  29. Alsop DC, Detre JA. Reduced transit-time sensitivity in noninvasive magnetic resonance imaging of human cerebral blood flow. J Cereb Blood Flow Metab 1996; 16:1236.
  30. Lehéricy S, Duffau H, Cornu P, et al. Correspondence between functional magnetic resonance imaging somatotopy and individual brain anatomy of the central region: comparison with intraoperative stimulation in patients with brain tumors. J Neurosurg 2000; 92:589.
  31. Bittar RG, Olivier A, Sadikot AF, et al. Presurgical motor and somatosensory cortex mapping with functional magnetic resonance imaging and positron emission tomography. J Neurosurg 1999; 91:915.
  32. Schulder M, Maldjian JA, Liu WC, et al. Functional image-guided surgery of intracranial tumors located in or near the sensorimotor cortex. J Neurosurg 1998; 89:412.
  33. Pardo FS, Aronen HJ, Kennedy D, et al. Functional cerebral imaging in the evaluation and radiotherapeutic treatment planning of patients with malignant glioma. Int J Radiat Oncol Biol Phys 1994; 30:663.
  34. Aronen HJ, Glass J, Pardo FS, et al. Echo-planar MR cerebral blood volume mapping of gliomas. Clinical utility. Acta Radiol 1995; 36:520.
  35. Brüning R, Seelos K, Yousry T, et al. Echo-planar magnetic resonance imaging (EPI) with high-resolution matrix in intra-axial brain tumors. Eur Radiol 1999; 9:1392.
  36. Hanson MW, Glantz MJ, Hoffman JM, et al. FDG-PET in the selection of brain lesions for biopsy. J Comput Assist Tomogr 1991; 15:796.
  37. Herholz K, Pietrzyk U, Voges J, et al. Correlation of glucose consumption and tumor cell density in astrocytomas. A stereotactic PET study. J Neurosurg 1993; 79:853.
  38. Levivier M, Goldman S, Pirotte B, et al. Diagnostic yield of stereotactic brain biopsy guided by positron emission tomography with [18F]fluorodeoxyglucose. J Neurosurg 1995; 82:445.
  39. Kaplan AM, Bandy DJ, Manwaring KH, et al. Functional brain mapping using positron emission tomography scanning in preoperative neurosurgical planning for pediatric brain tumors. J Neurosurg 1999; 91:797.
  40. Hamilton RJ, Sweeney PJ, Pelizzari CA, et al. Functional imaging in treatment planning of brain lesions. Int J Radiat Oncol Biol Phys 1997; 37:181.
  41. Thiel A, Pietrzyk U, Sturm V, et al. Enhanced accuracy in differential diagnosis of radiation necrosis by positron emission tomography-magnetic resonance imaging coregistration: technical case report. Neurosurgery 2000; 46:232.
  42. Barker FG 2nd, Chang SM, Valk PE, et al. 18-Fluorodeoxyglucose uptake and survival of patients with suspected recurrent malignant glioma. Cancer 1997; 79:115.
  43. Doyle WK, Budinger TF, Valk PE, et al. Differentiation of cerebral radiation necrosis from tumor recurrence by [18F]FDG and 82Rb positron emission tomography. J Comput Assist Tomogr 1987; 11:563.
  44. Janus TJ, Kim EE, Tilbury R, et al. Use of [18F]fluorodeoxyglucose positron emission tomography in patients with primary malignant brain tumors. Ann Neurol 1993; 33:540.
  45. Chao ST, Suh JH, Raja S, et al. The sensitivity and specificity of FDG PET in distinguishing recurrent brain tumor from radionecrosis in patients treated with stereotactic radiosurgery. Int J Cancer 2001; 96:191.
  46. Sasaki M, Kuwabara Y, Yoshida T, et al. A comparative study of thallium-201 SPET, carbon-11 methionine PET and fluorine-18 fluorodeoxyglucose PET for the differentiation of astrocytic tumours. Eur J Nucl Med 1998; 25:1261.
  47. Borgwardt L, Højgaard L, Carstensen H, et al. Increased fluorine-18 2-fluoro-2-deoxy-D-glucose (FDG) uptake in childhood CNS tumors is correlated with malignancy grade: a study with FDG positron emission tomography/magnetic resonance imaging coregistration and image fusion. J Clin Oncol 2005; 23:3030.
  48. Olivero WC, Dulebohn SC, Lister JR. The use of PET in evaluating patients with primary brain tumours: is it useful? J Neurol Neurosurg Psychiatry 1995; 58:250.
  49. Chen W, Cloughesy T, Kamdar N, et al. Imaging proliferation in brain tumors with 18F-FLT PET: comparison with 18F-FDG. J Nucl Med 2005; 46:945.
  50. Sun D, Liu Q, Liu W, Hu W. Clinical application of 201Tl SPECT imaging of brain tumors. J Nucl Med 2000; 41:5.
  51. Black KL, Hawkins RA, Kim KT, et al. Use of thallium-201 SPECT to quantitate malignancy grade of gliomas. J Neurosurg 1989; 71:342.
  52. Kaplan WD, Takvorian T, Morris JH, et al. Thallium-201 brain tumor imaging: a comparative study with pathologic correlation. J Nucl Med 1987; 28:47.
  53. Slizofski WJ, Krishna L, Katsetos CD, et al. Thallium imaging for brain tumors with results measured by a semiquantitative index and correlated with histopathology. Cancer 1994; 74:3190.
  54. Vertosick FT Jr, Selker RG, Grossman SJ, Joyce JM. Correlation of thallium-201 single photon emission computed tomography and survival after treatment failure in patients with glioblastoma multiforme. Neurosurgery 1994; 34:396.
  55. Barkovich AJ, Krischer J, Kun LE, et al. Brain stem gliomas: a classification system based on magnetic resonance imaging. Pediatr Neurosurg 1990-1991; 16:73.
  56. Patchell RA, Tibbs PA, Walsh JW, et al. A randomized trial of surgery in the treatment of single metastases to the brain. N Engl J Med 1990; 322:494.
  57. Jackson RJ, Fuller GN, Abi-Said D, et al. Limitations of stereotactic biopsy in the initial management of gliomas. Neuro Oncol 2001; 3:193.