Astrocytoma physical examination: Difference between revisions

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{{Astrocytoma}}
{{Astrocytoma}}
{{CMG}}; {{AE}} {{Ammu}}
{{CMG}}; {{AE}} {{Fs}}
==Overview==
==Overview==
Common physical examination findings of astrocytoma include  [[gait]] disturbances, [[Tachycardia]] or [[bradycardia]], [[Orthostatic hypotension]], reduced hearing acuity, [[nystagmus]], abnormal extra-ocular movement, nonreactive [[Pupil|pupils]], [[papilledema]], [[blurry vision]], head tilt, [[Altered mental status]], [[Clonus]] , [[Hyperreflexia]], [[Muscle rigidity]], proximal/distal muscle weakness unilaterally or bilaterally, [[Cranial nerves|cranial nerve]] involvement , unilateral/bilateral sensory loss in the upper/lower extremity, positive [[Trendelenburg's sign]], unilateral/bilateral [[tremor]] and [[Dysmetria]].
==Physical Examination==
==Physical Examination==
===Appearance of the Patient===
NOTE: Based on the location of the [[tumor]],we might have different [[signs]] and [[Symptom|symptoms]].
* Patients are usually well appearing and can have gait disturbances<ref name="pmid21721894">{{cite journal| author=Forbes JA, Mobley BC, O'Lynnger TM, Cooper CM, Ghiassi M, Hanif R et al.| title=Pediatric cerebellar pilomyxoid-spectrum astrocytomas. | journal=J Neurosurg Pediatr | year= 2011 | volume= 8 | issue= 1 | pages= 90-6 | pmid=21721894 | doi=10.3171/2011.4.PEDS1115 | pmc=PMC3779306 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21721894  }} </ref>
 
=== Appearance of the Patient ===
* Patients are usually well appearing and can have [[gait]] disturbances.<ref name="pmid21721894">{{cite journal| author=Forbes JA, Mobley BC, O'Lynnger TM, Cooper CM, Ghiassi M, Hanif R et al.| title=Pediatric cerebellar pilomyxoid-spectrum astrocytomas. | journal=J Neurosurg Pediatr | year= 2011 | volume= 8 | issue= 1 | pages= 90-6 | pmid=21721894 | doi=10.3171/2011.4.PEDS1115 | pmc=PMC3779306 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21721894  }} </ref>


===Vitals===
=== Vital Signs ===
====Pulse====
[[Tumor cell|Tumors]] which are located in the [[brain stem]] can cause [[heart rate]] and [[blood pressure]] disturbance:<ref name="pmid7161610">{{cite journal |vauthors=Telerman-Toppet N, Vanderhaeghen JJ, Warszawski M |title=Orthostatic hypotension with lower brain stem glioma |journal=J. Neurol. Neurosurg. Psychiatry |volume=45 |issue=12 |pages=1147–50 |date=December 1982 |pmid=7161610 |pmc=491700 |doi= |url=}}</ref>
=====Rate=====
* [[Tachycardia]] or [[bradycardia]]
*[[Bradycardia]] may be present
* [[Orthostatic hypotension]]


====Blood Pressure====
=== Skin ===
*[[Hypotension]] may be present
* Skin examination of patients with astrocytoma is usually normal.
=== HEENT ===
* Hearing acuity may be reduced


====Respiratory Rate====
* [[Nystagmus]] may be present
*[[Bradypnea]] may be present
* Extra-ocular movements may be abnormal
* [[Pupils]] may not react to light
* Ophthalmoscopic exam may be abnormal with findings of [[papilledema]] such as swollen disc, [[blurry vision]], venous engorgement.


=== Neck ===
* Head tilt may be present<ref name="pmid200264983">{{cite journal |vauthors=Ansell P, Johnston T, Simpson J, Crouch S, Roman E, Picton S |title=Brain tumor signs and symptoms: analysis of primary health care records from the UKCCS |journal=Pediatrics |volume=125 |issue=1 |pages=112–9 |date=January 2010 |pmid=20026498 |doi=10.1542/peds.2009-0254 |url=}}</ref>


===Skin===
=== Lungs ===
* Lesions may be present
* Pulmonary examination of patients with astrocytoma is usually normal.


<gallery widths=150px>
=== Heart ===
* Cardiovascular examination of patients with astrocytoma is usually normal.


UploadedImage-01.jpg | Description {{dermref}}
=== Abdomen ===
UploadedImage-02.jpg | Description {{dermref}}
* Abdominal examination of patients with astrocytoma is usually normal.


</gallery>
=== Back ===
* Back examination of patients with astrocytoma is usually normal.


===Eyes===
=== Genitourinary ===
* [[Nystagmus]] may be present
* Genitourinary examination of patients with astrocytoma is usually normal.
* Extra-ocular movements may be abnormal
* Pupils may not react to light
* Ophthalmoscopic exam may be abnormal with findings of papilledema such as swollen disc, blurry vision, venous engorgement,


===Ears===
=== Neuromuscular ===
* Hearing acuity may be reduced
* Patient is usually oriented to persons, place, and time
* [[Altered mental status]]
* [[Glasgow coma scale]] is 15 / 15
* [[Clonus]] may be present
* [[Hyperreflexia]] may be present
* [[Muscle rigidity]]
* Proximal/distal muscle weakness unilaterally or bilaterally
* [[Cranial nerves|Cranial nerve]] involvement may be present.
* Unilateral/bilateral sensory loss in the upper/lower extremity
* Abnormal [[Gait abnormality|gait]] may be present (trunkal ataxia)
* Positive [[Trendelenburg's sign]] may be present
* Unilateral/bilateral [[tremor]]
* [[Dysmetria]] may be present<ref name="pmid20026498">{{cite journal |vauthors=Ansell P, Johnston T, Simpson J, Crouch S, Roman E, Picton S |title=Brain tumor signs and symptoms: analysis of primary health care records from the UKCCS |journal=Pediatrics |volume=125 |issue=1 |pages=112–9 |date=January 2010 |pmid=20026498 |doi=10.1542/peds.2009-0254 |url=}}</ref><ref name="pmid16547083">{{cite journal |vauthors=Wilne SH, Ferris RC, Nathwani A, Kennedy CR |title=The presenting features of brain tumours: a review of 200 cases |journal=Arch. Dis. Child. |volume=91 |issue=6 |pages=502–6 |date=June 2006 |pmid=16547083 |pmc=2082784 |doi=10.1136/adc.2005.090266 |url=}}</ref><ref name="pmid17644483">{{cite journal |vauthors=Wilne S, Collier J, Kennedy C, Koller K, Grundy R, Walker D |title=Presentation of childhood CNS tumours: a systematic review and meta-analysis |journal=Lancet Oncol. |volume=8 |issue=8 |pages=685–95 |date=August 2007 |pmid=17644483 |doi=10.1016/S1470-2045(07)70207-3 |url=}}</ref>


===Neck===
=== Extremities ===
*[[Lymph nodes]] may be present
* Extremities examination of patients with astrocytoma is usually normal.


===Neurologic===
* Mental status may be normal. Patient is alert, concious and oriented.
* Trunkal ataxia may be present
* Hyperactive reflexes may be present
* Abducens nerve palsy
==References==
==References==


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Latest revision as of 17:14, 14 January 2019

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Fahimeh Shojaei, M.D.

Overview

Common physical examination findings of astrocytoma include gait disturbances, Tachycardia or bradycardia, Orthostatic hypotension, reduced hearing acuity, nystagmus, abnormal extra-ocular movement, nonreactive pupils, papilledema, blurry vision, head tilt, Altered mental status, Clonus , Hyperreflexia, Muscle rigidity, proximal/distal muscle weakness unilaterally or bilaterally, cranial nerve involvement , unilateral/bilateral sensory loss in the upper/lower extremity, positive Trendelenburg's sign, unilateral/bilateral tremor and Dysmetria.

Physical Examination

NOTE: Based on the location of the tumor,we might have different signs and symptoms.

Appearance of the Patient

  • Patients are usually well appearing and can have gait disturbances.[1]

Vital Signs

Tumors which are located in the brain stem can cause heart rate and blood pressure disturbance:[2]

Skin

  • Skin examination of patients with astrocytoma is usually normal.

HEENT

  • Hearing acuity may be reduced
  • Nystagmus may be present
  • Extra-ocular movements may be abnormal
  • Pupils may not react to light
  • Ophthalmoscopic exam may be abnormal with findings of papilledema such as swollen disc, blurry vision, venous engorgement.

Neck

  • Head tilt may be present[3]

Lungs

  • Pulmonary examination of patients with astrocytoma is usually normal.

Heart

  • Cardiovascular examination of patients with astrocytoma is usually normal.

Abdomen

  • Abdominal examination of patients with astrocytoma is usually normal.

Back

  • Back examination of patients with astrocytoma is usually normal.

Genitourinary

  • Genitourinary examination of patients with astrocytoma is usually normal.

Neuromuscular

Extremities

  • Extremities examination of patients with astrocytoma is usually normal.

References

  1. ↑ Forbes JA, Mobley BC, O'Lynnger TM, Cooper CM, Ghiassi M, Hanif R; et al. (2011). "Pediatric cerebellar pilomyxoid-spectrum astrocytomas". J Neurosurg Pediatr. 8 (1): 90–6. doi:10.3171/2011.4.PEDS1115. PMC 3779306. PMID 21721894.
  2. ↑ Telerman-Toppet N, Vanderhaeghen JJ, Warszawski M (December 1982). "Orthostatic hypotension with lower brain stem glioma". J. Neurol. Neurosurg. Psychiatry. 45 (12): 1147–50. PMC 491700. PMID 7161610.
  3. ↑ Ansell P, Johnston T, Simpson J, Crouch S, Roman E, Picton S (January 2010). "Brain tumor signs and symptoms: analysis of primary health care records from the UKCCS". Pediatrics. 125 (1): 112–9. doi:10.1542/peds.2009-0254. PMID 20026498.
  4. ↑ Ansell P, Johnston T, Simpson J, Crouch S, Roman E, Picton S (January 2010). "Brain tumor signs and symptoms: analysis of primary health care records from the UKCCS". Pediatrics. 125 (1): 112–9. doi:10.1542/peds.2009-0254. PMID 20026498.
  5. ↑ Wilne SH, Ferris RC, Nathwani A, Kennedy CR (June 2006). "The presenting features of brain tumours: a review of 200 cases". Arch. Dis. Child. 91 (6): 502–6. doi:10.1136/adc.2005.090266. PMC 2082784. PMID 16547083.
  6. ↑ Wilne S, Collier J, Kennedy C, Koller K, Grundy R, Walker D (August 2007). "Presentation of childhood CNS tumours: a systematic review and meta-analysis". Lancet Oncol. 8 (8): 685–95. doi:10.1016/S1470-2045(07)70207-3. PMID 17644483.

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