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Brain tumours in adults
The most common intracranial tumours in adults are metastases; the most common primary tumour is meningioma, and the most common malignant primary tumour is glioblastoma — each recognised by location, enhancement pattern and age.
Why it matters in the exam
Questions present a patient with morning headache, a first seizure in adulthood, personality change or a progressive focal deficit, plus an imaging description. They test a ring-enhancing tumour crossing the corpus callosum in an older patient (glioblastoma), an extra-axial dural-based lesion with a "tail" (meningioma), multiple lesions at the grey-white junction in a cancer patient (metastases), and uniform periventricular enhancement in an immunosuppressed patient (primary lymphoma). Remember the rules: dexamethasone for symptomatic oedema, no seizure prophylaxis in a patient who has never had a seizure, and in suspected lymphoma avoid steroids before biopsy because they "melt" the tumour. Glioblastoma treatment is maximal safe resection, radiotherapy and temozolomide. Tumour classification today rests on molecular markers as well as microscopy, so IDH mutation and MGMT methylation are part of diagnosis and prognosis.
Key points
- Metastases are the most common intracranial tumours in adults.
- Glioblastoma: older patient, ring enhancement, "butterfly"; resection, radiotherapy and temozolomide.
- Meningioma: extra-axial, dural-based, "dural tail"; sometimes observation only.
- Primary lymphoma: immunosuppressed patients; biopsy before steroids.
- Dexamethasone for symptomatic oedema; no seizure prophylaxis without a seizure.
Summary table
| Tumour | Features | Main treatment |
|---|---|---|
| Metastases | The most common; from lung, breast, melanoma, kidney and bowel; usually multiple, at the grey-white junction | Surgery for a single large metastasis, radiosurgery, radiotherapy; dexamethasone for oedema |
| Glioblastoma (IDH wild-type) | Older adults; ring enhancement with necrosis, crossing the corpus callosum ("butterfly") | Maximal safe resection, radiotherapy 60 Gy in 30 fractions with temozolomide, then 6 cycles of temozolomide; MGMT methylation predicts benefit |
| Meningioma | Women; extra-axial, dural-based, "dural tail", sometimes calcified | Small and asymptomatic — observation; symptomatic — surgery or radiotherapy |
| IDH-mutant glioma | Younger patients; seizures; oligodendroglioma with 1p/19q codeletion and calcifications | Surgery, radiotherapy and chemotherapy; better prognosis |
| Primary CNS lymphoma | Immunosuppressed (HIV, EBV) and older patients; uniform periventricular enhancement | Biopsy before steroids; high-dose methotrexate |
In the full version for subscribers
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Sources
- WHO Classification of Tumours of the Central Nervous System, 5th edition, 2021 — Gliomas, meningiomas and lymphoma
- EANO Guideline on the Diagnosis and Treatment of Diffuse Gliomas of Adulthood, 2021 — Glioblastoma treatment
- SNO/EANO Guideline on Anticonvulsant Prophylaxis in Brain Tumours, 2021 — Patients without seizures
Sources are given for further reading; the text is written afresh and not copied from them.
Reviewed by the Examqo AI Professor · 2026-11-06. The text may contain errors; when in doubt, check the source.