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Medical History and Physical Examination

The initial steps in the diagnostic "work-up" of patients who present with signs and symptoms suggestive of a brain tumor is a thorough medical history and physical evaluation. In reviewing the patient's history, the physician will pay particularly close attention to the following signs and symptoms if reported by the patient:

• Headaches - intensity, duration, location, characteristics (worse in morning, accompanied by nausea and/or vomiting)
• Seizures - intensity, duration, loss of consciousness
• Loss of balance or coordination
• Loss of memory
• Changes in vision, hearing, or smell
• Weakness or paralysis in an area of the body
• Difficulty with speech or swallowing

Imaging Studies

If your doctor suspects that your signs and symptoms may be caused by a brain tumor, he or she will order one or more radiological (imaging) studies to determine if a brain tumor may be present:

• Magnetic resonance imaging (MRI) - This is a standard imaging technique that doctors use to evaluate if a brain tumor is present. An MRI is a scan that uses magnetic fields, radiowaves, and a computer to generate a 3-dimensional image of the body's internal tissues and organs. An MRI enables doctors to visualize the brain in great detail and determine if a tumor is present.

• Computed tomography (CT) - This type of imaging technique is also used frequently to see if a brain tumor may be present. A special CT scanner is used to obtain multiple pictures of the brain and, with the use of a computer, the pictures are combined to generate a detailed image of the brain. A CT scan involves injecting a contrast dye into a vein that travels to the brain and enables doctors to better visualize and differentiate normal brain tissue from a brain tumor or other brain abnormalities.

Other types of imaging techniques that may be used in some cases to obtain additional information about brain tumors include:

• Positron emission tomography (PET) - This is a newer imaging technique that is useful for obtaining detailed information about the metabolism and physiology of cells in the body such as cancer cells. In most cases, a PET scan is used to provide additional information about a brain tumor rather than to diagnose the tumor which is usually accomplished with an MRI or CT scan. PET imaging can help doctors localize the specific area of the tumor for obtaining a biopsy and is also useful for detecting the recurrence of a brain tumor after treatment.

• Single-photon emission computed tomography (SPECT) - This imaging technique involves the intravenous (IV) injection of a radioactive substance such as Thallium-201 which is then taken up by both normal brain cells and cancer cells. A standard CT scan is then performed to produce a cross-sectional image of the brain. This test can be used to differentiate between low-grade and high-grade astrocytomas and is also useful in determining if a brain tumor has recurred after treatment.

• Magnetic resonance angiography (MRA) - This is a special imaging technique that enables doctors to visualize the blood vessels supplying the tumor and helps surgeons plan for the operation to remove the brain tumor.