Rule in and rule out

Rule in: • Headache increasing in severity at the L

temporal area
• Cognitive difficulties:
– Can’t fully follow commands
– Short term memory loss
– Takes some time to calculate
• Gait Disorder:
– Veering to the R when walking
• Aphasia
• Tonic - Clonic Seizure
• Mild R arm drift
• Cranial Nerve Palsy:
– CNVI: R Lateral Rectus Palsy, Diplopia
– CNVII: Mild Shallow R nasolabial fold
Rule out:
• Cannot be ruled out
Labs and imaging
• MRI w/ or w/o gadolinium enhancement
– the preferred diagnostic test for any patient suspected of
having a brain tumor
– Malignant Tumors: central areas of necrosis, and are
surrounded by edema of the neighboring white matter.
– Benign Tumors: Calcifications
• Non-Contrast CT Scan
– To rule out hemorrhagic stroke
• Biopsy
• Labs are rarely indicated or useful in diagnosing
management
Non-
Pharmacological
Management

Maximal surgical removal

or debulking
Pharmacological Symptomatic Tx:
Management 1. Dexamethasone
– To reduce edema and improve
neurologic function w/n hrs
after administration
– 8-16 mg/d
– Long term use can cause
toxicity
Pharmacological Symptomatic Tx:
Management 2. Antiepileptic Drug Therapy
– Levetiracetam, Topiramate
– Lamotrigine, Valproic Acid
– Lacosamide

– Phenytoin & Carbamazepine

interferes w/ glucocorticoid
and chemotherapy
Pharmacological
Management
RADIATION THERAPY is the
mainstay of treatment for
individuals with glioblastoma
and improves local control and
overall survival after surgery.