Clinical Evaluation for patient presenting with neurological deficits or seizures:

Thorough history of presentation, symptoms, and physical examination Computed tomography (CT) scan: Lesion that may be homo- or heterogenous with vasogenic edema. MRI with and without gadolinium if suspected glioma on CT scan: Contrast enhancement, edema, gyral enlargement all strongly suggest high grade tumor. Lack of contrast enhancement in the setting of edema, gyral enlargement suggest low grade tumor. Diffusion tensor imaging (DTI) allows for the visualization of tracts to assess tumor involvement in displacement of critical structures. Functional MRI is helpful primarily for dominant hemisphere gliomas involving eloquent regions. MR Spectroscopy can help delineate between glioma and other pathologies if the initial imaging and clinical presentation is not highly conclusive of glioma.

Initial Management

Symptom Management Antiepileptics if there is any suspicion for prior epileptic activity. In patients with new or worsening neurologic deficit, dexamethasone can improve clinical functioning by reducing vasogenic edema. Any signs or symptoms of increased intracranial pressure or impending hydrocephalus should prompt urgent neurosurgical evaluation and consideration for inpatient admission. Given the need for tissue diagnosis in most glioma patients, a thorough preoperative evaluation should be performed as well.