History

The type of neurological symptoms that result from an astrocytoma depends foremost on the site and extent of
tumor growth in the central nervous system (CNS). Onset of any of the following symptoms should alert the
clinician to the presence of a neurological disorder and indicate a requirement for further investigation (in
particular, with imaging studies such as magnetic resonance imaging [MRI] or computed tomography [CT]
scan, with and without contrast):

Altered mental status

Cognitive impairment
Headaches
Visual disturbances
Motor impairment
Seizures
Sensory anomalies
Ataxia
Astrocytomas of the spinal cord or brainstem are less common. Patients with these neoplasms present with
motor/sensory or cranial nerve deficits referable to the tumor's location.

Physical
A detailed neurological examination is required for the proper evaluation of any patient with an astrocytoma.
Because these tumors may affect any part of the CNS, including the spinal cord, and may spread to distant
regions of the CNS, a thorough physical examination referable to the entire neuraxis is necessary to define the
location and extent of disease.
Special attention should be paid to manifestations of increased intracranial pressure (ICP), such as the
following, to determine the risk of mass effect, hydrocephalus, and herniation:

Headache
Nausea and vomiting
Decreased alertness
Cognitive impairment
Papilledema
Ataxia
Localizing and lateralizing signs, including cranial nerve palsies, hemiparesis, sensory levels, alteration of deep
tendon reflexes (DTRs), and the presence of pathological reflexes (eg, Hoffman and Babinski signs), should be
noted. Once neurological abnormalities are identified, imaging studies should be sought for further evaluation.

Causes
The etiology of diffuse astrocytomas has been the subject of analytic epidemiological studies that have yielded
associations with various disorders and exposures.[10] With the exception of therapeutic irradiation[11] and,
perhaps, nitroso compounds (eg, nitrosourea), the identification of specific causal environmental exposures or
agents has been unsuccessful. Although concern has been raised regarding cell phone use as a potential risk
factor for development of gliomas, studies have yielded conflicting results. [12, 13, 14, 15, 16]

Children receiving prophylactic irradiation for acute lymphoblastic leukemia (ALL) have a 22-fold increased risk
of developing CNS neoplasms, including WHO grade II, III, and IV astrocytomas, with an interval for onset of 510 years. Furthermore, irradiation of pituitary adenomas has been demonstrated to carry a 16-fold increased
risk of glioma formation.[17]
Evidence exists for genetic susceptibility to glioma development. For example, familial clustering of
astrocytomas is well described in inherited neoplastic syndromes, such as Turcot syndrome, neurofibromatosis
type 1 (NF1) syndrome, and p53 germ line mutations (eg, Li-Fraumeni syndrome). Biological investigation has
implicated that mutations in specific molecular pathways, such as the p53-MDM2-p21 and p16-p15-CDK4CDK6-RB pathways, are associated with astrocytoma development and progression.
In addition, inherited elements of the immune response known as human leukocyte antigens (HLA) have been
both positively and negatively associated with an increased risk for the development of glioblastoma
multiforme. Two-thirds of low-grade astrocytomas have p53 mutations. [18]