Characteristics of Adult Brain Tumors in Neurology Emergency Unit in Prof. Dr. I.G.N.G. Ngoerah Hospital Bali 2020-2022

Abstract

Introduction: Brain tumors have a low incidence, with only 77,000 new cases reported annually in the United States, there is limited published data on brain tumor epidemiology in Indonesia, particularly in Bali. Therefore, we conducted this study to provide data that can explain the burden of care for adult brain tumors, particularly in Bali. Methods: The study collected secondary data from medical records at Prof. Dr. I.G.N.G. Ngoerah, a tertiary hospital in Bali Province. The sample consisted of adult patients aged 18 years or older who were treated in the neurology emergency department for brain tumors between 2020 and 2022, diagnosed through imaging or histopathological examination. The sample was further divided into primary and metastatic brain tumors. Primary brain tumors were categorized based on the major classification according to the type of cell precursor, while metastatic brain tumors were grouped based on the primary source of the tumor. The collected data were presented descriptively as proportions. Results: A total of 535 subjects were included in the study, out of which 298 (55.7%) had primary brain tumors and the remaining 237 (44.29%) cases were brain metastases. The incidence rate was found to be higher among males (278 cases, 51.96%) than among females (257 cases, 48.03%). The highest incidence rate (31.77%) was observed in the age group of 51 to 60 years. Majority of primary brain tumors were classified as glioma, especially high-grade glioma, accounting for 123 cases (41.27%), followed by meningioma with 94 cases (31.54%) and low-grade glioma with 44 cases (14.76%). The majority of primary brain tumors were located in the supratentorial area, accounting for 259 cases (86.91%). Although rare, the study found a sample of 6 cases (1.76%) with primary brain tumors in both the supratentorial and infratentorial areas, consisting of meningioma, Mesenchymal, non-meningothelial tumors, and hematolymphoid tumors. The majority of patients showed clinical features of headache (68.78%), hemiparesis (51.96%), and cranial nerve palsy (51.96%). Other clinical features noted were seizure (26.72%), loss of consciousness (32.33%), vomiting (11.77%), and visual impairment (8.59%). The study revealed that lung cancer was responsible for 43.88% of brain metastasis cases, making it the most common cancer to metastasize to the brain. Conclusions: Discovering the most common type of brain tumor in emergency departments can be a vital step in understanding the characteristics of brain tumor patients. This study has revealed that primary brain tumors, particularly high-grade gliomas, are the most frequently occurring type of brain tumor in emergency departments. Not only this, but the study also found that metastatic brain tumors most often resulted from lung cancer. These findings are unique to the Indonesian context and thus provide valuable insights into the epidemiology of brain tumors in emergency settings. It is hoped that this study will encourage further research in this area, and ultimately lead to improved care for brain tumor patients in emergency departments Keywords: Brain Tumor, Primary Brain Tumor, Metastatic Brain Tumor.