Clinical study of ocular signs and symptoms associated with intracranial tumors

Divya, K (2006) Clinical study of ocular signs and symptoms associated with intracranial tumors. Masters thesis, Coimbatore Medical College, Coimbatore.

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Abstract

INTRODUCTION: Developmentally, the visual system is an outgrowth from the central nervous system. Morphologically and functionally, the visual system, as a whole can be called as little brain. Tumors of the brain, its meningeal coverings, and spinal cord rank second only to stroke as the most common neurologic cause of death. Primary brain tumors account for 20% of all malignant tumors in children, second only to leukemia and about 2% of all cancers in adults. More than 50% of patients with intracranial tumors first produce ocular signs / symptoms / both. They are first seen by an ophthalmologist at an early stage, where there is greatest chance for optimum treatment of these lesions. Role of ophthalmologist 51 in the clinical management of neurologic tumor may involve: 1. Recognition of signs and symptoms suggesting intracranial neoplasm. 2. Use of appropriate diagnostic tests like CT / MRI, to distinguish tumor from other causes of progressive neuro ophthalmologic dysfunction. 3. Urgent referral of patients to neurologist for management . 4. Appreciation of prognosis and complications of management. 5. Awareness of treatment controversies and alternatives. AIM OF THE STUDY: 1. To study the value of ocular signs in predicting the presence of an intracranial tumour. 2. To correlate the ocular symptoms and signs with the location of the brain tumor. 3. To study the changes in ocular signs with treatment. MATERIALS AND METHODS: The study was conducted at the Coimbatore Medical College Hospital, Coimbatore. The period of study was from February 2004 to March 2006. Out of the sixty five patients screened, fifty one patients were included in this clinical study based on the following guidelines. Inclusion Criteria The patients who had typical CT scan abnormalities suggesting a brain tumor, were evaluated and followed up. Those patients who manifested with ocular signs suggestive of increased intracranial tension / compressive lesion in the brain were also evaluated with CT / MRI and included in the study. Exclusion Criteria Patients who had typical symptoms and signs suggestive of a space occupying lesion, but were found to have normal CT scans on investigation were excluded from the study. Out of the intracranial space occupying lesions, lesions other than tumors. (eg. Abscess, tuberculoma, hematoma etc.,) were not included in this clinical study. SUMMARY: The clinical study was conducted at the Coimbatore medical college hospital, Coimbatore during the period February 2004 to March 2006. Out of the 65 patients screened, 51 were finally selected based on the inclusion criteria. There were 25 male patients (49.02%) and 26 female patients (50.98%). The maximum incidence of brain tumors was seen in the 31-40 years age group (12 patients – 23.53%). Sex distribution was equal in patients under age of 20 years. In the 31-40 years age group there were more number of male patients (32%) than female patients (15.38%). CT Scan was the main diagnostic tool used to confirm the presence or absence of an intracranial mass. Gliomas were the single most common type of tumor (13 patients - 25.49%) based on the HPE report. Meningiomas and craniopharyngiomas were the next in frequency. Headache was the major presenting complaint occurring in 41 patients (80.39%). Gradual loss of vision was the most prominent ocular complaint (43.14%) suggesting a compressive effect on the visual pathway. CONCLUSION: Among the 51 patients studied 31-40 year age group was the most commonly affected. There was no sex predilection on the whole in this study. Glioma was found to be the most common Brain Tumor. Headache occurred as a non localizing symptom, being present in almost all the patients irrespective of the location of tumors. Loss of vision or a field defect was seen in lesions causing chiasmal compression (sellar, suprasellar or parasellar mass). Papilledema was the most striking ophthalmic sign and it was seen to occur in CPA tumors most frequently. In this era of advancing radiology, and costly neuro imaging techniques, ocular signs prove to be the best clinical tool in the diagnosis of intracranial tumors. Our study emphasizes the importance of team work and the need for multidisciplinary approach to the early diagnosis, appropriate management and follow up of patients with Intra cranial tumors.

Item Type: Thesis (Masters)
Uncontrolled Keywords: intracranial tumors; ocular signs; symptoms
Subjects: MEDICAL > Ophthalmology
Depositing User: Devi S
Date Deposited: 19 Oct 2017 11:59
Last Modified: 19 Oct 2017 11:59
URI: http://repository-tnmgrmu.ac.in/id/eprint/3752

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