Frontal lobe tumor
Introduction
Introduction to frontal tumor The frontal lobe tumor is a common intracranial tumor, and its incidence rate is the first in all tumors on the screen, accounting for about one-fifth of the total number of intracranial tumors. Glioma is often the most, accounting for 25.57% of the total number of intracranial gliomas; followed by meningioma, accounting for 11.45% of the total number of intracranial meningiomas; in addition, congenital tumors, metastases, etc., are often in this area occur. More common in adults, there is no significant difference in gender. Although this tumor is common, it is not perfect for understanding the anatomical structure and neurophysiological function of the frontal lobe. In the past 20 years, with the continuous advancement of neurosurgery, neurophysiology, and neuropsychiatry, the neurophysiology of the frontal lobe Although the symptoms caused by functional and frontal lobe lesions are further understood, there is still a lack of comprehensive and comprehensive understanding, especially the right frontal lobe is often considered to be a dumb zone or a quiet zone. Such patients have no obvious clinical symptoms and signs in the early stage, and rarely have significant dysfunction, which brings great difficulties to early diagnosis and has certain effects on the therapeutic effect and prognosis. basic knowledge The proportion of illness: 0.001% Susceptible people: no special people Mode of infection: non-infectious Complications: Acne
Cause
Frontal tumor cause
The cause of this disease is the same as that of other parts of the body. It is still not fully understood. A large number of studies have shown that there are oncogenes on the chromosomes of the cells and various congenital causes can cause them to occur. Possible factors for inducing this disease are: genetic factors. , physical and chemical factors as well as biological factors.
Prevention
Frontal lobe tumor prevention
Primary prevention refers to the promotion of health and the reduction of risk factors. This first line of defense is to promote the healthy lifestyle of the general population and reduce the harmful factors in the contact environment, so as to completely avoid the occurrence of cancer. In addition to preventing air, water, food and workplace carcinogens and suspected carcinogens, lifestyle changes in smoking, drinking and other bad habits are primary prevention.
Complication
Frontal tumor complications Complications
The cause is finally combined with lung infection, hemorrhoids and other deaths.
Symptom
Frontal lobe tumor symptoms common symptoms ataxia, phlegm, reflexes, dementia, expression, indifference, stuttering, memory impairment, disorientation
1. Symptoms and signs of increased intracranial pressure
Mainly for headache, vomiting and optic nerve head edema.
2. Mental symptoms
Psychiatric symptoms can be seen in other parts of the brain, but the psychiatric symptoms caused by frontal lobe tumors are more prominent and appear earlier, and the incidence is higher, especially when the frontal lobe is damaged. Frontal lobe tumors The psychiatric symptoms are mainly caused by memory impairment and personality changes. These conditions are more common in the frontal frontal and frontal lobe tumors. Early symptoms often show inattention, memory and comprehension, especially near memory. The decline is obvious, and the memory is preserved. With the gradual development of the disease, the thinking and comprehensive ability are obviously lost, the memory is far away, the self-knowledge and judgment are lost, and the orientation disorder of time and place appears. The patient gradually changes. For dementia, personality changes are also very common, mainly manifested as intelligent obstacles, expressions are indifferent, indifferent to the surrounding things, I do not know clean, life is lazy, some patients show loss of inhibition, irritability, temper, emotional euphoria, humor , childish, childlike dementia, frivolous, stupid, boring jokes, even strong crying, sometimes performance Unrestrained emotion or even furious attack, such as hair erect, increased blood pressure, dilated pupils and accompanied by attack action and so on.
The psychiatric symptoms caused by frontal lobe tumors often develop slowly, and obvious mental symptoms are easier to check out. However, in the early stage of the disease, slight mental changes are often ignored and ignored, especially when the relatives of the patients are asked in detail. It can be found that the incidence of psychiatric symptoms in frontal lobe tumors is generally around 60%. Psychiatric symptoms can occur at certain stages of the development of the disease in the intracranial tumor. Psychiatric symptoms can be seen in the lesions of the cerebral hemisphere. Subsequent lesions and patients with increased intracranial pressure can also occur, so the diagnosis of frontal lobe tumors alone is not enough.
3. Seizures
In frontal lobe tumors, seizures are often the first symptom, the incidence rate is about 33.3%, of which 4/5 are epilepsy without aura, 1/5 is localized epilepsy, tumor invades the anterior cerebral cortex 6 In the district and the 8th district, seizures were more consciously lost, the head and eyes turned to the opposite side of the lesion, the upper and lower limbs of the lesion were twitched, and the upper limbs were obvious. The episodes of a few patients only ended here, but most of them developed into a systemic episode. The tumor at the bottom of the forehead, especially near the midline of the bottom, may develop systemic seizures due to the development of the tumor to both sides. Due to the increase of intracranial pressure, localized epileptic seizures may occur when the tumor invades the central anterior gyrus. If the affected part is different, and the corresponding part of the lesion is twitched in the corresponding part of the limb, if the twitch begins from the thumb or forefinger, it is proved that the lesion is located in the lower part of the central anterior gyrus; if it starts from the sulcus, the lesion is located at the bottom of the central anterior gyrus, which is equivalent. In the vicinity of the lateral fissure, it is extremely rare to start from the foot or the big toe. If it occurs, the lesion should be considered to be located in the medial part of the parasagittal sinus. The progression of epilepsy is helpful for the localization of tumors. In addition, it should be noted that if the generalized epilepsy leads to systemic authors, most of them are organic lesions. If the patient has had paralysis before the seizure, After seizures, the sputum can be temporarily exacerbated; those who have not had sputum and have a sputum after seizures and are called temporary toad paralysis are called todd paralysis. This is not uncommon in clinical practice. In addition, individual patients can also behave. For certain movements of repeated movements, such as continuous blinking, body twisting and other special attacks.
3. Cone beam damage symptoms
In the frontal lobe tumor, the lesions of the contralateral abdominal wall and the cremaster reflex disappeared and the tonic reflex deformity occurred at the same time, which was often an early symptom. As the tumor continued to increase and the degree of invasion of the exercise area, the muscle on the contralateral side of the lesion may appear. Increased tension, hyperreflexia, often accompanied by sputum, sputum and wrist sputum, and finally different degrees of paralysis on the opposite side of the lesion, babinski sign is a representative of corticospinal tract lesions Significant signs, tumors in any part of the frontal cortex motor area can appear, anatomically due to the facial cortical motion projection area obliquely protruding forward, extremely vulnerable, so the frontal lobe tumor often has a central facial paralysis on the opposite side of the lesion, occurs The rate is 44.8%. This sign is especially obvious when talking and laughing. Therefore, it is considered to be one of the important signs of frontal lobe tumor. In addition, because the frontal lobe tumor is easily pressed or invaded by the cerebral palsy, it can appear. Bilateral pyramidal tract sign or ipsilateral pyramidal tract sign.
4. Sports aphasia
Patients with right hemisphere superiority may cause telekinetic aphasia when the tumor invades the broca area of the posterior inferior frontal gyrus. The clinical feature is that the patient's lips and tongue can move freely, understand the language of others, but cannot use words. Dialogue with people, the activities of the organ are not accessible, some can pronounce but can not constitute language, the patients with weaker damage are often incomplete sports aphasia, the patient can still send individual speech, but can not speak from the voice They can't be arranged in the necessary order, they can talk slowly, often say typos or language pauses, stuttering, so the individual voices that can be sent out are also chaotic, incomprehensible, and completely lose their ability to speak in serious cases.
When the tumor affects the dominance of the hemisphere in the middle and back of the hemisphere, it can cause writing. The patient can speak, understand, understand, but lose writing ability. Clinically, patients with complete motor aphasia often lose their ability to speak. At the same time, it is accompanied by a book.
5. Frontal lobe aphasia
The ataxia caused by frontal lobe tumor is caused by the damage of the frontal-ponto-brain-brain bundle. After the anatomical frontal fiber reaches the pons, the cerebral traversing fiber passes to the contralateral cerebellum and reaches the small brain. The nucleus, which emits fibers, mostly terminates in the red nucleus, and a few from the red nucleus to the ventrolateral nucleus of the thalamus and then reach the motor area. This is the so-called cortical cerebellar-cortical circuit. Therefore, the frontal lobe tumor can have a similar cerebellar origin. Abortion, early stage of frontal lobe tumors, especially frontal tumors, if not accompanied by increased intracranial pressure, does not produce dyskinesia, there will be no convulsions, but complex and sophisticated high-level dyskinesias, such as embroidery, wear When a needle and a continuous action are engaged, there is a clumsy and uncoordinated relationship, and speech and action contradict each other. For example, when a patient picks up an item, the patient can clearly say it, but the action is reversed, or the language is clumsy or wrong. Dissociation with the action, tremors on the opposite side of the lesion, slight ataxia in the lower extremities, general observation is not easy to find, when the paralyzed patient can walk quickly or make a quick turn, some people think About half of the patients with leaf damage can develop ataxia. When the frontal lobe is obviously damaged, the patient's gait is swaying and the side is obviously damaged. The lesion is significantly awkward on the contralateral limb, and often walks excessively outward. Stepping down, but such patients with poorly resolved distance and continuous motor dysfunction are often insignificant, and there is no more nystagmus.
6. The gripping movement of strong grip reflection
The front part of the frontal lobe tumor damage, especially when the frontal gyrus is close to the central anterior gyrus, due to the loss of control over the random movement, when the object touches the palm of the opposite side of the lesion and the palm of the hand, it causes the fingers and palms to flex and grasp the object tightly. The phenomenon of holding the hand is called strong grip reflection; when the palm of the patient is touched by the object, both the hand and the upper limb move toward the object. If the palm of the hand is continuously touched, the upper limb can be explored to the parties until it touches the object. Holding this object, called the groping movement, the strong grip reflex and the groping movement occur on one side at the same time, which is often an important basis for the diagnosis of frontal lobe tumors.
7. Other symptoms
When the frontal lobe tumor is located at or near the forehead, it can affect or oppress the olfactory nerve, leading to loss of olfaction. The tumor will be posteriorly compressed, and the optic nerve may have atrophy of the optic nerve. The contralateral nerve will have optic nerve nipple due to increased intracranial pressure. Edema (foster-kennedy syndrome), patients with frontal tumors sometimes have urinary incontinence or urinary urgency, resulting in unpleasant panic urination, even fecal incontinence, double frontal tumor or tumor invasion of the central anterior gyrus, sometimes can appear Sucking reflex or sputum reflex, the extra-pyramidal symptoms may appear in the deep frontal tumor, and there may be slight tremor of the contralateral limb. In addition, the frontal lobe tumor may occasionally exhibit a stupor state, and the patient may remain in a fixed state for a long time without fatigue; A small number of patients may have poor food, sexual dysfunction and so on.
8. Clinical features of tumors in various parts of the frontal lobe
(1) The frontal frontal tumor is often the first symptom of headache or mental symptoms. The symptoms of intracranial hypertension and mental symptoms are obvious, while the dyskinesia is rare. Epilepsy is often a generalized episode without aura. In the frontal lobe, the mental retardation is particularly obvious, and the patient may only have increased intracranial pressure without a physical indication.
(2) The clinical manifestations of the central frontal lobe are between the anterior and posterior frontal, the intracranial pressure is more obvious, the psychiatric symptoms are common, and the seizures have two forms of systemic and localized seizures, dyskinesia and pyramidal tract The levy is more than the forehead, and the tumor is rare after the forehead.
(3) The first symptoms of the posterior frontal lobe are often localized epilepsy or weak limbs, limb dyskinesia and pyramidal tract signs are obvious, the symptoms of increased intracranial pressure are higher than the pre-frontal, the central tumor is mild, and the mental symptoms are less common. Left axillary tumors are also often associated with motor aphasia.
(4) The tumor of the frontal lobe is rare, mostly meningeal disease. In addition to the symptoms of increased intracranial pressure, the patient is often accompanied by localized signs such as dysosmia, visual impairment, visual field defect, pathological optic atrophy, and side view. Papillary edema, known as the foster-kennedy syndrome.
Examine
Frontal lobe tumor examination
1. Skull flat film
Skull flat examination can be used for localization or qualitative diagnosis of some frontal lobe tumors. For example, oligodendroglioma can sometimes have calcified plaques, which are characterized by cord-like, spotted or lumpy, interdigitated calcium spots. Astrocytoma, calcification occurs mostly in the wall or tumor of the tumor, calcification is mostly curved, cord-like, flaky or spotted; ependymoma occurs in the lateral ventricle, often with spotted calcification Shadow, meningioma calcification mostly presents larger clumps, higher density, clear outline, calcification of sand-type meningioma is the most common, frontal glioma, meningioma, metastases, etc. close to the skull, can absorb and change the skull Thin, destructive and defect, and meningiomas are also common in patients with skull hyperplasia. When the frontal lobe tumor leads to increased intracranial pressure, there is an increase in cerebral gyrus, cranial sutures, and changes in the shape and displacement of the saddle.
Its main features are as follows:
(1) frontal lobe tumor
1) anterior and posterior images: the lateral ventricle is displaced to the healthy side, and the displacement is not significant; the ventricle of the diseased side is unclear, and the anterior horn is pressed.
2) Lateral image: the front anterior angle is displaced upwards or upwards; when narrowed, the bottom is flattened and curved or lumps are formed; the front end of the lateral ventricle is flattened or curved, and the third ventricle is well filled. It can be seen that the lower part is flattened and displaced backwards and downwards, and there is no abnormality in the midbrain aqueduct and the fourth ventricle.
(2) frontal tumor
1) Front and rear image:
The anterior and posterior images of the diseased side of the ventricle are unclear, due to the tumor leading to the anterior horn occlusion or stenosis; the lateral ventricle is shifted to the healthy side; the transparent septum and the third ventricle are linearly moved to the opposite side; the tumor invades both sides The shift is light or ectopic.
2) Lateral image:
On the lateral image, the anterior horn is closed, and the front end of the lateral ventricle has a curved compression or filling defect, and is displaced backwards and downwards. The impression is lighter at the upper part, the front angle becomes shorter, narrows and shifts backward. The anterior and posterior parts of the third ventricle are often flattened and displaced backwards, and there is no abnormality in the midbrain aqueduct and the fourth ventricle.
(3) frontal sagittal sinus tumor
1) Front and rear image:
On the anterior and posterior images, the pressure on the ipsilateral ventricle was significantly shifted down and flattened, and the outer upper corner became dull and moved downward; the transparent septum and the third ventricle were more obliquely moved to the opposite side. The lateral corpus callosum and the cingulate sulcus are also flattened, moved down and then displaced to the opposite side.
2) Lateral image:
On the lateral image, the anterior horn and the anterior part of the body are displaced downward, the top is compressed and flattened, and an arc-shaped indentation or a block-like shadow protrudes; narrowing or closing, the lower part of the third ventricle is flattened and down. Rear displacement, no change in the midbrain aqueduct and the fourth ventricle.
(4) Lower frontal tumor
1) Front and rear image:
On the anterior and posterior images, the ipsilateral lateral ventricle became smaller, and it was obviously shifted to the contralateral side. The transparent septum and the third ventricle were curved to the opposite side.
2) Lateral image:
The lateral position like the upper anterior ventricle anterior horn and the anterior part of the body are uniformly displaced downward; the top of the anterior horn and the top of the lower corner can be flattened by pressure, such as backward growth, the lower corner is narrowed and displaced backwards, The anterior and posterior part of the third ventricle were deformed and displaced rearward and downward, and there was no change in the midbrain aqueduct and the fourth ventricle.
2. Internal carotid artery angiography
The frontal lobe tumor mainly leads to the upper part of the internal carotid artery, the anterior cerebral artery 2/3 and the middle part of the middle artery, and the different directions and different degrees of vascular displacement and deformation of the frontal ascending artery.
Its main performance characteristics are as follows:
(1) frontal lobe tumor
1) Front and rear image:
The anterior and posterior images of the anterior cerebral artery and the ascending segment are laterally outwardly displaced, and are concavely curved. The curved contour can indicate the upper boundary of the tumor, because the lower part of the vertical section of the anterior artery has moved outward. Position, so see its relative upward shift and shorten, the tumor is biased to one side, the lateral position is more obvious; the middle line or the two sides involved, there may be no midline shift or slight shift.
2) Lateral image:
The upper segment of the internal carotid artery is displaced downward and backward, so that the siphon bending is compressed and flattened, and the internal carotid artery branch is displaced backward. The tumor is close to the midline, and the vertical segment of the anterior artery and the knee segment are straightened and displaced backwards. The extra-cerebral tumors are mostly curved, which can depict the contour of the tumor. If the tumor is out of the way, the anterior artery has no such changes, and the lateral artery segment can be displaced downward. The frontal ascending artery is straightened and displaced backwards and downwards. The tumor is in the middle line or involves both sides, which can affect both internal carotid artery and anterior cerebral artery.
3) Venous period:
It can be seen that the striate vein and the septal vein are straightened and displaced upward and backward. The anterior segment of the cerebral vein is displaced backward and the curvature is increased, and the venous angle is also shifted upward. The occurrence of these changes is related to the tumor size.
(2) frontal tumor
1) Front and rear image:
In the anterior and middle cerebral arteries, the horizontal sections of the two arteries are straightened, lengthened, and gently moved downward. The vertical section of the anterior artery is curved to the contralateral side, and the distance from the middle artery is increased. The lateral fissure is slightly moved outward. An annular shape with an upper opening is formed, and the frontal artery is often straightened.
2) Lateral image:
The vertical segment of the anterior cerebral artery and the knee segment are displaced backwards, and the curvature becomes dull; the larger the tumor, the more the posterior, the more obvious the change is. The ascending aorta is straightened and displaced backwards and backwards; the closer the tumor is In the midline, the lower displacement of the anterior portion of the lateral segment of the middle artery is smaller and lighter.
The striatum vein and the transparent septal vein can be moved down, the venous angle becomes sharp and moves backward, and the internal cerebral vein becomes shorter and later, and the curvature increases, which is hump-like.
(3) frontal sagittal sinus and paratemporal tumor
1) Front and rear image:
The anterior cerebral artery is displaced to the contralateral side. The above segment is more obvious. The periorbital artery is moved downward. The parasagittal sinus tumor is more likely to be positive for cerebral palsy. The cerebral palsy of the cerebral palsy is negative. Lateral and straight or curved to the lateral side of the ipsilateral, the tumor from the free edge of the cerebral palsy can shift the ipsilateral periorbital artery and the anterior cerebral artery to the same side, or both sides The arteries and anterior segments of the anterior cerebral artery are separated from each other and moved down.
2) Lateral image:
The anterior segment of the periorbital artery and the iliac crest artery descends and straightens, while the curvature of the corpus callosum becomes sharper. The anterior segment of the anterior artery is moved downwards, and the iliac artery and its branches are pressed downward or Displaced backwards, each branch is curved or straightened, the tumor is biased to the latter, the proximal and middle segments of the periorbital artery are moved downward, and the branches of the temporal and periorbital arteries are forward and backward, often curved. Around the tumor, the upper segment of the internal carotid artery and the upper arm of the curved canal and the middle cerebral artery, the lateral fissure and the ascending aorta can be gently displaced to the lower or lower, the venous angle becomes smaller and the internal cerebral vein goes backward. Or shift below.
(4) Middle and posterior tumors of the frontal lobe
1) Front and rear image:
Most of the anterior cerebral arteries are slightly arcuate or square to the contralateral side. The frontal sign can be positive. The upper part of the internal carotid artery and the anterior cerebral artery are moved down. The horizontal section of the middle artery is extended. When moved down, the lateral fissure segments can be displaced to the lower side. When the tumor invades the basal ganglia inward, the bean veins become straight and shift to the medial side.
2) Lateral image:
The upper segment of the internal carotid artery is displaced downward, the siphon curve is flattened, the horizontal segment of the middle cerebral artery is moved downward, and the lateral segment is obviously displaced to the lower or lower part. The tumor is located in the middle of the forehead and the branch of the frontal ascending artery is branched. That is, the frontal branch and the central anterior collateral branch are obviously shifted downward or downward; the posterior group branches, that is, the central anterior branch and the anterior branch can be straightened, the tumor is located in the posterior part of the frontal lobe, and the anterior and posterior groups are respectively forward Lateral and posterior displacement, the lateral fissure arteries are flattened and moved downwards. When the tumor invades the basal ganglia, the branches of the bean veins are stiff, and the internal cerebral veins are displaced to the opposite side. The anterior segment and the venous angle can be moved upwards. Position, the basal vein is displaced downwards inward.
3. Ultrasound
In the ultrasonography of frontal lobe tumor, the midline wave can be seen with moderate to healthy side shift, the frontal pole, frontal tumor and double tumor, the midline wave is not displaced, but different degrees of tumor pathology, tumor compression space The hole causes obstructive hydrocephalus, which can increase the amplitude of the ventricle, and the distance between the lateral ventricle wave and the midline wave becomes larger, so the degree of hydrocephalus can be estimated.
4. EEG
The EEG of the frontal lobe has the following characteristics:
(1) The occurrence rate of localized delta waves is about 83% higher;
(2) 40% of the one-sided or bilateral paroxysmal single rhythmic delta waves, especially the frontal or basal surface of the frontal lobe;
(3) About one-third of the unilateral frontal lobe tumors also have a diffuse delta wave, but the general amplitude is low, often becoming a mixed delta wave; the background alpha wave is normal in 1/3 of the cases. In general, the higher the tumor position, the lighter the abnormality of ;
(4) Bilateral frontal lobe tumors are characterized by the appearance of mutually independent polymorphic delta waves in the bilateral forehead. The larger side of the tumor is more obvious, and the wave and lazy wave appear in a wider range.
5. Brain CT examination
CT mainly diagnoses intracranial tumors by comparing the density of tumors with surrounding tissues and the displacement and deformation of normal structures (such as ventricles). The frontal lobe tumors are often gliomas and meningioma, which generally show higher density; common anterior horn of lateral ventricle Deformed under pressure.
Diagnosis
Diagnosis and diagnosis of frontal lobe tumor
The frontal lobe tumors generally develop slowly, and the early clinical symptoms are mild. As the tumors continue to increase, the clinical symptoms gradually increase. In the detailed inquiry of the medical history, careful and comprehensive examination should be noted that the same can be caused with the frontal lobe. Identification of other intracranial diseases with similar symptoms of the tumor.
(a) subdural hematoma
Subfrontal hematoma is a common clinical disease. It can be seen at any age and has a significant history of trauma. Symptoms of increased intracranial pressure appear shortly or months after injury. The local signs are not obvious, but the mental symptoms are more obvious. A small number of patients may have seizures, especially chronic or subacute subdural hematoma. It is difficult to distinguish tumors according to clinical manifestations. It is often necessary to make a clear diagnosis by means of angiography and CT examination. The frontal subdural hematoma is used as a neck. In angiography, the anterior cerebral artery is displaced to the contralateral side in the anterior and posterior images, and the middle cerebral artery is depressed and displaced to the inside in different degrees, and there is often a half-moon-like blood vessel between the blood vessel and the inner plate of the skull. District, CT is very useful for the location of hematoma.
(B) frontal abscess
The frontal lobe abscess is basically the same as the clinical symptoms and signs of the tumor, but the brain abscess is secondary to the infection of other parts of the body. The onset is acute, there is a history of fever, the peripheral blood image and cerebrospinal fluid polymorphonuclear leukocytes are increased, and carotid angiography The microvascular-venous phase of about 50% of brain abscesses can show a uniform opaque area of the wall, which can be regarded as a characteristic change of brain abscess. CT examination of brain abscess shows a clear low-density area, while tumors are generally For the high-density area, it is easy to identify, but there are a few brain abscesses that are difficult to differentiate from the tumor before surgery, and can be diagnosed by surgical exploration.
(three) craniopharyngioma
Craniopharyngioma is more common in school-age children and young people before the age of 20, rarely seen in adults, and frontal lobe tumors are more common in adults. The first symptoms of craniopharyngioma are more common in endocrine dysfunction. Children are common in growth retardation, adulthood. People are more likely to have sexual dysfunction, while frontal lobe tumors have no such symptoms. The early symptoms are mostly mental disorders. The symptoms of craniopharyngioma are rare and mild. The frontal lobe tumors cause papilledema and early visual impairment. In the case of secondary atrophy of the late optic nerve, visual acuity occurs, while craniopharyngioma usually causes primary atrophy of the optic nerve, while visual acuity is associated with the early stage. The craniopharyngioma often has an eggshell on the saddle or in the saddle. Calcification is accompanied by changes in the shape and bone of the sella, while the frontal lobe is rarely calcified, while a few calcified tumors have a calcified plaque and a shape that is not as typical as the craniopharyngioma.
(four) pituitary tumors
Pituitary adenomas are more common in adults. The main symptoms are pituitary dysfunction, hemiplegic hemiplegic, headache, optic nerve atrophy, and some patients show acromegaly. The sella is spherically enlarged and the diagnosis is not difficult. However, when the tumor grows to the saddle, the patient may have psychiatric symptoms, seizures, when the tumor affects the inner capsule, the cerebral pedicle or the anterior cerebral artery, and the right artery of the brain affects its blood circulation, hemiplegia may occur, and attention should be paid to the frontal lobe. Tumor phase differentiation, in addition to the frontal tumor often have vision, visual field changes, should also pay attention to the identification of pituitary tumors.
(5) Olfactory sulcus meningioma
Olfactory disorders and mental disorders are the main clinical features of olfactory meningioma. In addition, headache, vision loss, and seizures are common symptoms. In addition to a few frontal lobe tumors, frontal lobe tumors rarely have olfactory and visual impairments. The skull of the meningioma often shows abnormality of the anterior cranial fossa or tumor calcification, bilateral carotid angiography, vascular transposition of the anterior cerebral artery, and the lateral anterior cerebral artery is curved upward. The distance from the base line of the anterior cranial fossa is widened, and the frontal artery is curved upward in the arch. The middle cerebral artery is not significantly displaced, even close to normal. The upper part of the internal carotid artery is slightly inclined backward, sometimes it can be displaced backwards and backwards. The siphon segment is deflected, and the dome artery is often displaced downward in the lateral pull image. According to the above characteristics, it is not difficult to distinguish with the frontal lobe tumor.
(6) Saddle nodule meningioma
Most of the first symptoms are visual impairment, followed by headache, endocrine disorders can occur in the late stage, and symptoms such as lethargy, phantom odor, and olfactory loss can occur. Any adult with monocular or bilateral temporal hemianopia, the optic nerve is primary atrophy, and the butterfly There is no obvious change in the saddle, and the saddle nodule meningioma should be suspected. It should be distinguished from the tumor at the bottom of the frontal lobe.
(7) Lateral ventricle tumor
Lateral ventricle tumors are rare. The clinical symptoms vary with tumor location and size. The first symptoms are mostly headaches. The nature is intermittent or paroxysmal. In severe cases, nausea, vomiting, visual impairment, and epilepsy are common. Seizures and limb dyskinesia, cranial ultrasound and EEG examination showed that 90% of one side of the cerebral hemisphere occupying lesions, ventricular angiography and cerebral angiography have localization, qualitative value, easy to identify frontal lobe tumors.
(8) Frontal tuberculoma
The frontal lobe is one of the most common sites of tuberculoma. Its clinical symptoms are very similar to those of frontal lobe tumors. Tuberculosis has a history of tuberculosis, low fever, and accelerated erythrocyte sedimentation rate. A few patients have characteristic changes in cerebrospinal fluid due to tuberculous meningitis. However, there are still many frontal tuberculomas that can be determined when they are surgically explored.
(9) Cerebrovascular diseases
Frontal vascular diseases are common with cerebral vascular malformations and intracranial aneurysms.
Frontal cerebral vascular malformation
More distributed in the middle cerebral artery and anterior cerebral artery supply area, bleeding and seizures are often the first symptoms of cerebral vascular malformations, headache, progressive neurological dysfunction and mental decline are also common, a small number of patients can be heard in the eye or forehead Intracranial vascular murmur, CT examination, common scanning lesions are often of equal density, surrounded by low-density areas, intracranial hemorrhage can be seen in the corresponding high-density area, when there is subarachnoid hemorrhage, it can also show that after contrast agent enhancement, The diseased vascular area can be high-density, and sometimes it can be seen to supply arteries and drainage veins. Cerebral angiography is the main basis for differential diagnosis of cerebrovascular malformation and intracranial tumors.
2. Intracranial aneurysms
It occurs in the cerebral arterial ring and its main branches. It accounts for 85% of the internal carotid artery system in the anterior semicircular ring. About 90% of the patients with aneurysms are caused by subarachnoid hemorrhage, which is a sudden severe headache. At the same time, it is accompanied by nausea, vomiting, photophobia, pale complexion, neck stiffness, positive stagnation, etc. Severe patients may have disturbance of consciousness or mental symptoms. Other patients may have deeper into one hemisphere due to bleeding. The sputum is faint and gradually worsened. Some patients have a reabsorption of arachnoid granules due to the large amount of bleeding. The intracranial pressure gradually rises after hemorrhage, the headache does not relieve for a long time, and the papilledema gradually becomes obvious. These patients should Further examination (EEG, ultrasound, or even cerebral angiography or CT scan) to rule out the possibility of tumor hemorrhage or hematoma formation.
(10) Intracranial parasitic diseases
Frontal parasitic diseases often cause seizures and psychiatric symptoms, clinically similar to tumors, but according to epidemiology, parasitic exposure history, parasites exist in other parts of the body, positive skin tests and blood and cerebrospinal fluid complement test, etc. It is not difficult to identify with frontal lobe tumors.
