By Charles J. Vecht MD, PhD (auth.), David Schiff MD, Patrick Y. Wen MD (eds.)
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Extra resources for Cancer Neurology in Clinical Practice
Fewer than 10% of patients with metastatic brain tumors, astrocytomas, or glioblastomas have chronic nonprogressive headaches. " The headache is usually bifrontal but worse ipsilateral to the tumor. Seventy-two percent of patients in one series (2) had bilateral headache, and 25% reported unilateral headaches. Frontal headaches predominated, occurring in 68 % of patients, and were associated with supratentorial tumors or increased intracranial pressure. In another series (63), only 22% of patients were found to have unilateral headaches.
Unsurprisingly, few patients had a unilateral headache contralateral to the site of the tumor. HEADACHE QUALITY AND INTENSITY In the acute setting, brain tumor headache is usually described as being severe, excruciating, and unrelieved by most medications. However, in the acute recurrent or chronic setting, the headaches can be mild, moderate, or severe in intensity (median of 7 on a scale of 1-10) (2). The headache was found to be severe in 37%, moderate in 46%, and mild in 17%. Oral medications such as acetylsalicylic acid relieved the headache in 58% of patients in one series and 42% of patients in another series (6).
It is held together by continuous belts of tight or pentalaminar junctions, and has few microvesicles in the cytoplasm. Gaps or fenestrations are conspicuously lacking. This specialized endothelium is the anatomic locus for the bloodbrain-barrier (BBB) as defined almost a century ago with the use of cationic dyes and in the 1970s by various electron dense tracers suitable for ultrastructural investigation. Regions of the brain that have been known for years to "lay outside the bloodbrain-barrier," such as choroid plexus and area postrema, are CORTICOSTEROIDS IN NEURO-ONCOLOGY freely permeable to cationic dyes and tracers in current usage because in these regions the capillaries are fenestrated.
Cancer Neurology in Clinical Practice by Charles J. Vecht MD, PhD (auth.), David Schiff MD, Patrick Y. Wen MD (eds.)