The full diagnostic work-up
history with physical and neurologic examination.
evaluation: the preferred diagnostic investigation is
magnetic resonance imaging without and with
contrast enhancement. The advantages here lie in the vast amount of
detail that can be visualised without exposure to ionising radiation.
this cannot be used
for those carrying some kind of metal implants even if in most cases is
safe, except for a few times. The radiologist should be always informed of
any metal or electronic device (pace-maker..)
it can be a very
uncomfortable experience for those who are claustrophobic, in this case the
open MRI can be an alternative option
lack of widespread
the relatively high
cost of such an investigation
Another widely use
diagnostic tool is computerised tomography. Advantages here are excellent
imaging of bony structures, short duration of the procedure, greater
availability and it is cheaper.
In specific cases a
lumbar puncture can be useful to measure the
cerebral spinal fluid (CSF)
that bathes the brain and spinal cord, and
is possible to analyse a small amount allowing a differential diagnosis
between infections and tumours.
Surgical removal of
the tissue sample through a biopsy or in the contest of a surgical
resection, whenever it is possible: the pathological diagnosis is the
important final step allowing a differential diagnosis between eventually
benign/malign tumours. The neurophatologist will see the type of cells
present, their abnormalities and speed of growth, plus other biological
features that will allow tumours to be rated and graded from the least
malignant to the most aggressive ones.
Whenever the surgical
approach is not possible, the radiological diagnosis can be a satisfactory
criterion for the diagnosis itself, based on the features of the lesions
that can be highly indicative of their nature.
Should the tumour turn
out to be a benign one, late diagnosis does not always imply a negative
prognosis. Should the tumour, however, turn out to be a
malignant one, a possible consequence of late diagnosis is that at times,
even at the point of first presentation of symptoms, the tumour is already
either much too large with massive infiltration, or spread over many locations
in the brain, thereby precluding effective neurosurgical intervention of any
kind right from the start.