Brain Tumors

Extract

Brain tumors can affect people of all ages.¹ Unfortunately, the incidence of brain tumors is on the rise for all age groups, especially older adults.² Therapists who work with patients with brain tumors could benefit from knowing the pathophysiology and clinical presentation of brain tumors. The purposes of this update are to relate recent classification systems to the traditional classifications of brain tumors and to examine current neuroimaging techniques. Given the scope of this article, only the most common types of brain tumors are discussed.

Classification of Brain Tumors

Brain tumors may be benign or malignant, or primary or metastatic. The term “benign” may imply that a complete cure is possible, but this is not always true.^3,4 A benign tumor can be life threatening if it is very large or if it results in increased intracranial pressure,^3,4 cerebral edema,⁴ or herniation syndromes³ such as a transtentorial herniation, especially if it is located in a critical area of the brain such as the pons or medulla. In contrast, malignant brain tumors are potentially life threatening.³ Primary brain tumors, which originate directly from cells in the brain, rarely spread outside of the central nervous system.⁵ Metastatic brain tumors originate from tissues outside of the brain.⁵ Kernahan and Ringretz independently developed 2 different classification scales for brain tumors based on the degree of malignancy.^6–8 Brain tumors are graded from I (“least malignant”) through IV (“most malignant”) on the Kernahan scale.⁷ The Ringretz scale is a similar 3-grade scale that combines Kernahan scale grades III and IV into Ringretz scale grade III.⁸