What mimics a brain tumor?

Pseudotumor Cerebri

Pseudotumor cerebri literally means «false brain tumor.» It is likely due to high pressure within the skull caused by the buildup or poor absorption of cerebrospinal fluid (CSF). The disorder is most common in females between the ages of 20 and 50. Symptoms, which closely mimic those of large brain tumors, include:

• Headache
• Nausea
• Vomiting
• Pulsating sounds within the head

Obesity, other treatable diseases, and some medications can cause raised intracranial pressure and symptoms of pseudotumor cerebri. Diagnosis is based on a thorough medical history and physical examination. If a diagnosis is confirmed, close, repeated ophthalmologic exams are required to monitor any changes in vision.

Drugs may be used to reduce fluid buildup and to relieve pressure. Weight loss through dieting or weight loss surgery and cessation of certain drugs (including oral contraceptives, tetracycline, and a variety of steroids) may lead to improvement. Surgery may be needed to remove pressure on the optic nerve. Therapeutic shunting, which involves surgically inserting a tube to drain CSF from the lower spine into the abdominal cavity, may be needed to remove excess CSF and relieve the pressure.

The disorder may cause progressive, permanent vison loss in some individuals. Pseudotumor cerebri can be a recurring problem.

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Learn About Clinical Trials

Clinical trials are studies that allow us to learn more about disorders and improve care. They can help connect patients with new and upcoming treatment options.

How can I or my loved one help improve care for people with pseudotumor cerebri ?

Consider participating in a clinical trial so clinicians and scientists can learn more about pseudotumor cerebri and related disorders. Clinical research uses human volunteers to help researchers learn more about a disorder and perhaps find better ways to safely detect, treat, or prevent disease.

All types of volunteers are needed— those who are healthy or may have an illness or disease— of all different ages, sexes, races, and ethnicities to ensure that study results apply to as many people as possible, and that treatments will be safe and effective for everyone who will use them.

For information about participating in clinical research visit NIH Clinical Research Trials and You. Learn about clinical trials currently looking for people with pseudotumor cerebri at Clinicaltrials.gov .

Where can I find more information about pseudotumor cerebri ?

Information may be available from the following resource:

Intracranial Hypertension Research Foundation
Phone: 360-693-4473

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Order publications from the NINDS Catalog

The NINDS Publication Catalog offers printed materials on neurological disorders for patients, health professionals, and the general public. All materials are free of charge, and a downloadable PDF version is also available for most publications.

Aggressive brain tumours can mimic normal brain repair processes

Scientists at the UCL have made a ‘surprising’ discovery that glioblastoma, an aggressive brain cancer, mimics normal brain repair in white matter, which leads to the tumour becoming less malignant.

In the study on mice, funded by Cancer Research UK and published in Nature Communications , researchers used these novel findings to identify drugs which could be used, or repurposed, to harness this response (feature) and treat the cancer.

Using the pre-clinical mouse models, the researchers found that Pranlukast, a drug clinically approved for treating asthma in people, suppressed glioblastoma growth.

Explaining the research, lead author, Professor Simona Parrinello ( UCL Cancer Institute), said: “We know glioblastoma often develops and spreads in the brain’s white matter but it has been unclear why this happens or what molecules are involved in this process.

“In this experimental study, we wanted to understand what impact white matter has on cancerous tumour cells.”

Glioblastomas are the most aggressive type of cancer that begins within the brain. One of the main reasons that glioblastomas are so difficult to treat is that they spread into different regions of the brain. Approximately half the brain is grey matter, made up of cell bodies including neurons, the other half, referred to as white matter is composed of neuronal projections which are insulated by fatty membranes and therefore appear white. Tumour cells use the white matter as a route to spread to other brain regions.

In this study, the research team discovered that tumour cells, mimic brain repair, in that they attempt to repair the damage that the growing tumour mass causes to the brain’s white matter.

Professor Parrinello, who is Group Leader at the Samantha Dickson Brain Cancer Unit, part of UCL Cancer Institute, explained: “To our surprise, when the tumour cells spread into the brain’s white matter, it made the glioblastoma less aggressive.

“This response is caused by the growing tumour injuring the white matter and in turn responding to this wound-like environment by attempting to repair it.

“This causes the tumour cells to mature into cells that resemble the normal brain cells that make up the white matter.

“In this mature state, tumour cells become less able to grow and spread.”

The team found that this tumour response can be exploited for glioblastoma treatment using drugs that promote normal white matter repair, such as Pranlukast.

Professor Parrinello added: « Glioblastoma is the most common and aggressive type of primary brain tumour. There are currently no effective treatments for glioblastoma, so recurrence is inevitable. As a result, prognosis for glioblastoma patients remains extremely poor with a median survival of less than 18 months. Here we identified a potential new approach to treat glioblastoma and show that a drug currently in clinical use for asthma suppresses glioblastoma growth and spread in preclinical models.»

Around 2,200 people in the UK (mostly adults) are diagnosed with glioblastoma each year and currently prognosis is extremely poor with average survival rate of around six to 18 months.

Michelle Mitchell, chief executive of Cancer Research UK, said: “Brain tumours are notoriously hard to treat because we still don’t know enough about the biology of the disease, and current treatments are not effective enough. This early research is fascinating as it could mean an existing asthma drug may help people with glioblastoma. Repurposing a drug that has already passed safety tests would save a lot of time compared to developing a new treatment from scratch, time which would make an incredible difference to the lives of people affected by glioblastoma.”

Links

• Research paper published in Nature Communications
• Professor Simona Parrinello’s research profile
• UCL Cancer Institute
• Samantha Dickson Brain Cancer Unit at UCL
• Cancer Research UK

Image

• Tumour cells (green) invading through white matter tracts (purple): Credit Dr Lucy Brooks (UCL Cancer Institute)

Media contact

Henry Killworth

Tel: +44 (0) 7881 833274

When a stroke is a stroke mimic?

If you are familiar with the signs of a stroke – one side of the face drooping, weakness in the arms and difficulty speaking – then you know it is important to seek immediate medical attention. When patients arrive at emergency departments exhibiting these symptoms, patients, family and emergency medical personnel think of stroke first and begin treatment as quickly as possible. Time is brain when a stroke strikes. However, Medical Director of the Oklahoma Stroke & Neurological Institute at Hillcrest Medical Center Andre Fredieu, M.D., said there is reason to pause if something doesn’t seem exactly right. “I always consider stroke first, unless there are unusual symptoms,” he said. “Conditions that look like a stroke may actually not be a stroke, but a stroke mimic.”

Stroke mimics are other medical conditions that present similar symptoms of a stroke that are non-vascular conditions. One of the most common stroke mimics is a seizure, which researchers believe account for as many as 20% of all stroke mimics. Other common stroke mimics include migraines, syncope, sepsis, brain tumor and metabolic derangement (low sodium or low blood sugar). “It is important to be aware of these mimics so patients who are not having a stroke do not get the acute treatment for a stroke, like tPA (tissue plasminogen activator), when they don’t need it,” Fredieu said. “I would estimate 15-20% of patients who come to the emergency center at Hillcrest with stroke symptoms actually have a stroke mimic.” National research indicates that number could be as high as 30%.

How can medical personnel determine who is having a stroke and who is having a stroke mimic, especially when time is critical? Fredieu says both the patient’s history of the onset of symptoms, as well as a clinical exam including head CT or MRI imaging will rule in or rule out stroke. “When a patient is having a transient ischemic stroke (TIA), there are abrupt symptoms,” he says. “If it is a stroke, the symptoms appear simultaneously. With other conditions like complicated migraines or seizures, weakness may start in one arm and then move to another part of the body, like a leg, with a stroke mimic. If the patient says they have generalized weakness that is not what we typically see with a stroke. Then we have the clinical examination using imaging to determine if a stroke has occurred.”

Patients and family members can assist medical personnel with detailed information about the patient’s history. If they have a personal history of migraines or seizures, for example, it is important to share that with the staff when they arrive at the emergency center. However, Fredieu said symptoms that look like a stroke should never cause anyone to delay seeking treatment. “We don’t want our patients to feel like they have to have a medical degree,” he said. “They need to go for a clinical evaluation immediately. Don’t self diagnose.”

Stroke mimics vary with age, Fredieu said. “Under the age of 50, most stroke mimics are migraines, epilepsy, seizures, multiple sclerosis or high blood pressure that causes swelling in the brain,” he said. “Over the age of 50, most patients experiencing a stroke mimic are the result of epilepsy, metabolic derangement or a mass lesion in the brain.”

Fredieu said that while stroke mimics are not new medical conditions by any means, awareness of the need to diagnose a mimic when the clear signs of a stroke are not present is a growing understanding. “There is a greater understanding now,” he said. “It takes years of experience to feel comfortable making these diagnoses. That is why it is important neurology care is available to emergency medical personnel.”

To learn more about the Oklahoma Stroke & Neurological Institute, please click here. Hillcrest Medical Center is a certified Primary Stroke Center.