OPTIC NERVE GLIOMA

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HREF="id32.htm" TARGET="_top" TITLE="HEMORRHAGIC DISEASE IN A NEW BORN"><U>HEMORRHAGIC DISEASE IN A NEW BORN</U></A>   |   <B>OPTIC NERVE GLIOMA</B>   |   <A HREF="id36.htm" TARGET="_top" TITLE="New Born Assessment "><U>New Born Assessment </U></A>   |   <A HREF="id38.htm" TARGET="_top" TITLE="laryngomalacia"><U>laryngomalacia</U></A>   |   <A HREF="id39.htm" TARGET="_top" TITLE="CRANIOSYNOSTOSIS "><U>CRANIOSYNOSTOSIS </U></A>   |   <A HREF="id40.htm" TARGET="_top" TITLE="DANDYWALKER MALFORMATION "><U>DANDY-WALKER MALFORMATION </U></A>   |   <A HREF="id41.htm" TARGET="_top" TITLE="DEJERINESOTTAS DISEASE "><U>DEJERINE-SOTTAS DISEASE </U></A>   |   <A HREF="id42.htm" TARGET="_top" TITLE="DOWN SYNDROME "><U>DOWN SYNDROME </U></A>   |   <A HREF="id43.htm" TARGET="_top" TITLE="Respiratory Syncytial Virus (RSV)"><U>Respiratory Syncytial Virus (RSV)</U></A>   |   <A HREF="id44.htm" TARGET="_top" TITLE="FABRY DISEASE "><U>FABRY DISEASE </U></A>   |   <A HREF="id45.htm" TARGET="_top" 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HSPACE="0" VSPACE="0">minimal proptosis restricted,</B></div> <div> <B><IMG BORDER="0" SRC="Symb075c00b700c8cc333300.gif" HEIGHT="13" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0"> decreased eye movement </B></div> <div> <B><IMG BORDER="0" SRC="Symb075c00b700c8cc333300.gif" HEIGHT="13" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">strabismus </B></div> <div> <B><IMG BORDER="0" SRC="Symb075c00b700c8cc333300.gif" HEIGHT="13" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">neoplasm of the </B><FONT SIZE="2" COLOR="#800000" FACE="Arial" ><B>optic</B></FONT><B> </B><FONT SIZE="2" COLOR="#800000" FACE="Arial" ><B>nerve</B></FONT><B> </B></div> <div> <B><IMG BORDER="0" SRC="Symb075c00b700c8cc333300.gif" HEIGHT="13" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">also known as juvenile pilocytic astrocytoma </B></div> <div> <B><IMG BORDER="0" SRC="Symb075c00b700c800008000.gif" HEIGHT="13" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Optic</B><FONT SIZE="2" COLOR="#3333CC" FACE="Arial" ><B> </B></FONT><B>nerve</B><FONT SIZE="2" COLOR="#3333CC" FACE="Arial" ><B> </B></FONT><B>glioma</B><FONT SIZE="2" COLOR="#3333CC" FACE="Arial" ><B> in adults are glioblastoma </B></FONT></div> <div> <B><IMG BORDER="0" SRC="Symb075c00b700c800008000.gif" HEIGHT="13" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Optic</B><FONT SIZE="2" COLOR="#3333CC" FACE="Arial" ><B> </B></FONT><B>nerve</B><FONT SIZE="2" COLOR="#3333CC" FACE="Arial" ><B> </B></FONT><B>glioma</B><FONT SIZE="2" COLOR="#3333CC" FACE="Arial" ><B> is the most common cause of </B></FONT><B>optic</B><FONT SIZE="2" COLOR="#3333CC" FACE="Arial" ><B> </B></FONT><B>nerve</B><FONT SIZE="2" COLOR="#3333CC" FACE="Arial" ><B> enlargement </B></FONT></div> <div> <B><IMG BORDER="0" SRC="Symb075c00b700c8cc333300.gif" HEIGHT="13" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">it accounts for 80% of </B><FONT SIZE="2" COLOR="#800000" FACE="Arial" ><B>optic</B></FONT><B> </B><FONT SIZE="2" COLOR="#800000" FACE="Arial" ><B>nerve</B></FONT><B> tumors </B></div> <div> <B><IMG BORDER="0" SRC="Symb075c00b700c8cc333300.gif" HEIGHT="13" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">1% of all intracranial tumors </B></div> <div> <B><IMG BORDER="0" SRC="Symb075c00b700c8cc333300.gif" HEIGHT="13" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">2% of childhood intraorbital masses. </B></div> <div> <B>Demographics </B></div> <div> <B><IMG BORDER="0" SRC="Symb075c00b700c8cc333300.gif" HEIGHT="13" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">80% are in children under 10 years old </B></div> <div> <B><IMG BORDER="0" SRC="Symb075c00b700c8cc333300.gif" HEIGHT="13" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">peak age is 5-8 </B></div> <div> <B><IMG BORDER="0" SRC="Symb075c00b700c8cc333300.gif" HEIGHT="13" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">90% of patients are under the age of 20. </B></div> <div> <B><IMG BORDER="0" SRC="Symb075c00b700c8cc333300.gif" HEIGHT="13" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">more common in females </B></div> <div> <B><IMG BORDER="0" SRC="Symb075c00b700c8cc333300.gif" HEIGHT="13" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">10-50% are in neurofibromatosis patients, especially if bilateral. </B></div> <div> <B><IMG BORDER="0" SRC="Symb075c00b700c8cc333300.gif" HEIGHT="13" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">15% of NF patients have an </B><FONT SIZE="2" COLOR="#800000" FACE="Arial" ><B>optic</B></FONT><B> </B><FONT SIZE="2" COLOR="#800000" FACE="Arial" ><B>glioma</B></FONT><B>. </B></div> <div> <B>Clinical Course </B></div> <div> <B><IMG BORDER="0" SRC="Symb075c00b700c800008000.gif" HEIGHT="13" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Optic</B><FONT SIZE="2" COLOR="#3333CC" FACE="Arial" ><B> </B></FONT><B>nerve</B><FONT SIZE="2" COLOR="#3333CC" FACE="Arial" ><B> </B></FONT><B>glioma</B><FONT SIZE="2" COLOR="#3333CC" FACE="Arial" ><B>s grow very slowly and have similar pathology as juvenile pilocytic astrocytomas of the cerebellum. </B></FONT></div> <div> <B><IMG BORDER="0" SRC="Symb075c00b700c8cc333300.gif" HEIGHT="13" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">typically intraorbitally and grow in a fusiform shape </B></div> <div> <B><IMG BORDER="0" SRC="Symb075c00b700c8cc333300.gif" HEIGHT="13" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">25% are limited to the orbit </B></div> <div> <B><IMG BORDER="0" SRC="Symb075c00b700c8cc333300.gif" HEIGHT="13" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">malignant degeneration is very rare in children </B></div> <div> <B><IMG BORDER="0" SRC="Symb075c00b700c8cc333300.gif" HEIGHT="13" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">if the tumor begins in the chiasm, it is likely to invade surrounding parenchyma regardless of age</B></div> <bR> </td> <td valign="top" height=370 BGCOLOR="#FFFFFF" TEXT="#080000"> <div> OPTIC NERVE GLIOMA</div> <div> [read also neurofibromatosis on neuropediatry</div> <div> <IMG SRC="0b6a1230.gif" border=0 width="417" height="291" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Most <FONT SIZE="3" COLOR="#800000" FACE="Arial" >glioma</FONT>s of the <FONT SIZE="3" COLOR="#800000" FACE="Arial" >optic</FONT> <FONT SIZE="3" COLOR="#800000" FACE="Arial" >nerve</FONT> and chiasm (where the two <FONT SIZE="3" COLOR="#800000" FACE="Arial" >optic</FONT> <FONT SIZE="3" COLOR="#800000" FACE="Arial" >nerve</FONT>s come together and separate again inside the brain) are discovered before the age of 10 years. </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Surgery is the treatment of choice for <FONT SIZE="3" COLOR="#800000" FACE="Arial" >glioma</FONT>s of the <FONT SIZE="3" COLOR="#800000" FACE="Arial" >optic</FONT> <FONT SIZE="3" COLOR="#800000" FACE="Arial" >nerve</FONT> (as opposed to the chiasm), particularly when there is profound visual loss or when there is significant protrusion of eyeballs (proptosis). </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Radiation therapy for treatment of <FONT SIZE="3" COLOR="#800000" FACE="Arial" >optic</FONT> <FONT SIZE="3" COLOR="#800000" FACE="Arial" >nerve</FONT> and chiasmal <FONT SIZE="3" COLOR="#800000" FACE="Arial" >glioma</FONT>s remains controversial. </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Some radiation oncologists advocate deferring radiation in patients with no symptoms or in those with lesser visual disturbance until there are signs of disease progression</div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">In general, tumors of the <FONT SIZE="3" COLOR="#800000" FACE="Arial" >optic</FONT> <FONT SIZE="3" COLOR="#800000" FACE="Arial" >nerve</FONT> (intracranial as well as intraorbital) have an excellent prognosis following complete surgical excision and/or irradiation </div> <div> <FONT SIZE="3" COLOR="#800000" FACE="Arial" ><IMG BORDER="0" SRC="Symb075c00b700f000008000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">optic</FONT> <FONT SIZE="3" COLOR="#800000" FACE="Arial" >nerve</FONT> which is also known as <FONT SIZE="3" COLOR="#FF0000" FACE="Arial" ><B><U>juvenile pilocytic astrocytoma</U></B></FONT>. </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000008000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Optic<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT>nerve<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT>glioma<FONT SIZE="3" COLOR="#000000" FACE="Arial" > in adults is a glioblastoma</FONT></div> <bR> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">ONG is the most common cause of <FONT SIZE="3" COLOR="#800000" FACE="Arial" >optic</FONT> <FONT SIZE="3" COLOR="#800000" FACE="Arial" >nerve</FONT> enlargement, it accounts for 80% of <FONT SIZE="3" COLOR="#800000" FACE="Arial" >optic</FONT> <FONT SIZE="3" COLOR="#800000" FACE="Arial" >nerve</FONT> tumors, 1% of all intracranial tumors, and 2% of childhood intraorbital masses. </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">80% are in children under 10 years old, and the peak age is 5-8. 90% of patients are under the age of 20. It is more common in females, and 10-50% are in neurofibromatosis patients, especially if bilateral. 15% of NF patients have an <FONT SIZE="3" COLOR="#800000" FACE="Arial" >optic</FONT> <FONT SIZE="3" COLOR="#800000" FACE="Arial" >glioma</FONT>. </div> <bR> <bR> <div> <B>Course</B></div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">ONGs grow very slowly and have similar pathology as juvenile pilocytic astrocytomas of the cerebellum. They typically begin intraorbitally and grow in a fusiform shape along the <FONT SIZE="3" COLOR="#800000" FACE="Arial" >optic</FONT> <FONT SIZE="3" COLOR="#800000" FACE="Arial" >nerve</FONT> toward the globe or toward the brain. Only 25% are confined to the orbit at the time of diagnosis. Malignant degeneration is very rare in children, but in adults, most die within a year of diagnosis. If the tumor begins in the chiasm, it is likely to invade surrounding parenchyma regardless of age. ONGs may extend posteriorly to involve the chiasm, the <FONT SIZE="3" COLOR="#800000" FACE="Arial" >optic</FONT> tracts and the <FONT SIZE="3" COLOR="#800000" FACE="Arial" >optic</FONT> radiations. </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">They often stabilize after childhood. </div> <bR> <bR> <div> <B>Clinical Presentation:</B></div> <div> Symptoms are :</div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">proptosis, </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">decreased visual acuity, </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">exophthalmus, </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000008000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">optic<FONT SIZE="3" COLOR="#000000" FACE="Arial" > atrophy, </FONT></div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">papilledema, </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">nystagmus, </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">increased intracranial pressure, </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">and visual field defects. </div> <div> <B><IMG BORDER="0" SRC="Symb075c00b700f00000ff00.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Disturbances in hypothalamic function such as precocious puberty, increased growth, panhypopituitarism, and diabetes insipidus can occur with large chiasmatic lesions</B><FONT SIZE="3" COLOR="#000000" FACE="Arial" >. </FONT></div> <div> <B><IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Fifty percent of patients are less than 10 years old, </B></div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">and 90% present by 20 years old it is associated with neurofibromatosis in <B><U>10-20% of cases. </U></B></div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">F = M child / young adult (75% < 10 yrs, 90% < 20 yrs) </div> <bR> <bR> <bR> <div> <B><U>Etiology/Pathophysiology:</U></B></div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Arise from </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000008000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">optic<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT>nerve<FONT SIZE="3" COLOR="#000000" FACE="Arial" >s, </FONT></div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000008000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">optic<FONT SIZE="3" COLOR="#000000" FACE="Arial" > chiasm, </FONT></div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">and hypothalamus.</div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0"> Is slow growing and low grade.</div> <bR> <bR> <div> <B><U>Imaging Findings:</U></B></div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Fusiform expansion of the <FONT SIZE="3" COLOR="#800000" FACE="Arial" >optic</FONT> <FONT SIZE="3" COLOR="#800000" FACE="Arial" >nerve</FONT> is seen. </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Lesions in the hypothalamus and <FONT SIZE="3" COLOR="#800000" FACE="Arial" >optic</FONT> chiasm grow into the third ventricle</div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0"> isodense mass +/- enhancement rarely calcified</div> <div> <B><U><IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0"><IMG SRC="0a4583b0.gif" border=0 width="600" height="571" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"><IMG SRC="0a558d90.gif" border=0 width="600" height="729" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></U></B><IMG SRC="0b4ac360.jpg" border=0 width="428" height="310" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"><IMG SRC="0b8efed0.gif" border=0 width="751" height="493" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">60-70% extend along the <FONT SIZE="3" COLOR="#800000" FACE="Arial" >optic</FONT> tract and are therefore not resectable. They rarely calcify, hemorrhage or become cystic. </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">On MR, there is usually mild contrast enhancement. The affected <FONT SIZE="3" COLOR="#800000" FACE="Arial" >optic</FONT> <FONT SIZE="3" COLOR="#800000" FACE="Arial" >nerve</FONT> should be greater than 3 mm in diameter, or 1 mm wider than the unaffected side. It should be hypo- to isointense to muscle on T1 and hyperintense on T2. Fat supression sequences should be performed to see the entire extent of the lesion since it may appear to be more extensive than it is on T2-weighted images secondary to edema. </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Classically, there is a downward kink of the affected <FONT SIZE="3" COLOR="#800000" FACE="Arial" >optic</FONT> <FONT SIZE="3" COLOR="#800000" FACE="Arial" >nerve</FONT> a few mm posterior to the globe. This may be secondary to increased mucin content, or from <FONT SIZE="3" COLOR="#800000" FACE="Arial" >nerve</FONT> elongation. The <FONT SIZE="3" COLOR="#800000" FACE="Arial" >optic</FONT> canal is typically widened, and if there is intracranial extension, there should be a low signal lobulated mass. If the mass is large, it will often have some cystic areas and some enhancing solid regions. </div> <bR> <div> <IMG SRC="0b9c4bf0.gif" border=0 width="708" height="447" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"><IMG SRC="0babcea0.gif" border=0 width="700" height="490" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></div> <bR> <div> <B><U>Histopathologically, </U></B></div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">most <FONT SIZE="3" COLOR="#800000" FACE="Arial" >optic</FONT> <FONT SIZE="3" COLOR="#800000" FACE="Arial" >nerve</FONT> <FONT SIZE="3" COLOR="#800000" FACE="Arial" >glioma</FONT>s are Grade I or juvenile pilocytic (hair-like) astrocytomas. </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">These tumors consist of benign-appearing, round to spindle-shaped astrocytic nuclei with dendrite-like cytoplasmic processes.</div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0"> Rosenthal fibers are a characteristic but not a diagnostic degenerative change--fusiform, cigar- shaped, eosinophilic structures within the astrocyte cytoplasmic processes.</div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0"> Some lesions may also show small areas of necrosis within the tumors which show myxomatous cystic spaces. </div> <bR> <div> <B><U><IMG SRC="0a862970.jpg" border=0 width="610" height="407" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"><IMG SRC="0aab8820.jpg" border=0 width="696" height="386" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"><IMG SRC="0b2409d0.jpg" border=0 width="576" height="669" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></U></B>fusiform enlargement of the <FONT SIZE="3" COLOR="#800000" FACE="Arial" >optic</FONT> <FONT SIZE="3" COLOR="#800000" FACE="Arial" >nerve</FONT>. </div> <div> <B><U><IMG SRC="0acccc50.jpg" border=0 width="716" height="453" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"><IMG SRC="0b31f610.jpg" border=0 width="543" height="353" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"><IMG SRC="0aea6a70.jpg" border=0 width="678" height="423" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"><IMG SRC="0b0e3dd0.jpg" border=0 width="739" height="477" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></U></B></div> <bR> <bR> <div> <B><U><IMG BORDER="0" SRC="Symb075c00b700f000008000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">optic</U></B><FONT SIZE="3" COLOR="#000000" FACE="Arial" ><B><U> </U></B></FONT><B><U>nerve</U></B><FONT SIZE="3" COLOR="#000000" FACE="Arial" ><B><U> meningioma</U></B></FONT></div> <bR> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">female (80%) </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">middle age </div> <div> <U><IMG BORDER="0" SRC="Symb075c00b700f0ff000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">(24% occur before 10 yrs, but are a/w neurofibromatosis</U><FONT SIZE="3" COLOR="#000000" FACE="Arial" >) </FONT></div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">tubular, hyperdense mass </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">intense "tramtrack" enhancement </div> <bR> <div> <B>DDX</B></div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000008000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Optic<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT>nerve<FONT SIZE="3" COLOR="#000000" FACE="Arial" > sheath meningioma</FONT></div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Infiltration by leukemia or lymphoma</div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Perineural hematoma</div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Papilledema of intracranial hypertension</div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Patulous subarachnoid space</div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000008000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Optic<FONT SIZE="3" COLOR="#000000" FACE="Arial" > neuritis</FONT></div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Sarcoidosis</div> <bR> <bR> <div> <B><U>Types  OF BRAIN TUMORS IN KIDS</U></B></div> <div> <B><U><IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">  </U></B><B>Gliomas </B></div> <div> <B><IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">   Astrocytoma </B></div> <div> <B><IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0"> Ependymoma  </B></div> <div> <B><IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0"> Ganglioglioma  </B></div> <div> <B><IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0"> </B></div> <div> <B><U> Midline Tumors </U></B></div> <div> <B><U><IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0"> </U></B><B>  Hypothalamic- </B></div> <div> <B><IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">  Chiasmatic (Optic Nerve) Gliomas  </B></div> <div> <B><IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0"> Craniopharyngioma  </B></div> <div> <B><IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0"> Pineal Region Tumors</B><B><U>  </U></B></div> <div> <B><U> </U></B></div> <div> <B><U> </U></B></div> <div> <B><U>   Pituitary Tumors  </U></B></div> <div> <B><IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0"> Meningioma  </B></div> <div> <B><U> </U></B></div> <bR> </td> </tr></table></body>