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Neurology Week 3 2018/19 > 2: Intracranial neoplasms > Flashcards

2: Intracranial neoplasms Flashcards

1
Q

Which eye sign should be checked for on fundoscopy of someone with a headache?

A

Papilloedema

indicates CN II compression due to raised ICP, will progress to visual loss if untreated

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2
Q

Children tend to get ___tentorial tumours.

What gait do they present with?

A

infratentorial tumours

ataxic gait, tiptoeing

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3
Q

Brain tumours are common in which population?

A

Children

Second most common cancer after leukaemia

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4
Q

What are some of the symptoms of an intracranial tumour?

A

Headache

N&V

Seizures

Visual disturbance

Sensory / motor problems

Neurological deficit - changes in behaviour, personality, language

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5
Q

What is the Monro Kellie hypothesis?

A

Cranial vault has a fixed volume

So anything that reduces that volume (e.g tumour, bleeding, infection) will cause an INCREASE IN INTRACRANIAL PRESSURE (ICP)

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6
Q

What happens to the brain if intracranial pressure increases?

A

Compression (causing neurological symptoms)

Extreme compression causes herniation

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7
Q

What is Cushing’s triad of signs following a severe brain herniation?

Why is it important?

A

Hypertension

Bradycardia

Irregular breathing

If untreated, patient will die imminently

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8
Q

What are red flag headache symptoms which may indicate a brain tumour?

A

New onset in patients aged > 55

Early morning headache

Headaches which interrupt sleep

Unexpected weight loss

Hx malignancy, immunosuppression

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9
Q

Does the brain have any pain receptors?

A

No

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10
Q

Do the meninges have any pain receptors?

A

Yes

e.g photophobia, which is caused by meningeal irritation

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11
Q

What are some examples of neurological deficit caused by brain tumours?

A

Diplopia - double vision

Speech problems - articulation/comprehension

Perseveration - repeating an action or word after a stimulus has stopped

Dyspraxia - lack of coordination

Neglect - inability to see anything in a visual field; see “the man who fell out of bed”

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12
Q

Which systems must you examine in someone presenting with new onset neurological symptoms?

A

Full neurological examination

Eyes - i.e direct fundoscopy, visual acuity, fields, eye movements…

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13
Q

What do MRI scans pick up compared to CT scans?

A

Blood

plus they’re higher definition

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14
Q

What are three important investigations for intracranial tumours?

A

CT/MRI scan

Biopsy

Fundoscopy

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15
Q

Cancers of astrocytes are ___ depending on their severity.

A

graded

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16
Q

Grade I astrocyte tumours mostly affect which population?

A

Children

17
Q

All astrocytomas graded II or above are ___.

A

malignant

18
Q

How are grade I astrocytomas treated?

A

Surgery

19
Q

What do grade I astrocytomas look like on MRI?

A

Solid

Enhance well (glow white)

20
Q

What condition may brain tumours cause if they block the flow of CSF around the ventricles?

A

Hydrocephalus

21
Q

Patients with low grade (II) astrocytomas tend to present with which symptom?

A

Seizures

22
Q

Do low grade (II) astrocytomas enhance well on injection of contrast?

A

No

23
Q

Low grade (I.e II and III) astrocytomas will ___ over time unless they are removed surgically.

A

grow

24
Q

How are grade II astrocytomas treated?

A

Surgery

+/- chemo/radiotherapy, often combined

25
Q

Which grades of astrocytomas are definitely malignant?

A

III and IV

26
Q

What is a grade IV astrocytoma called?

Can they be removed surgically?

A

Glioblastoma

Usually no

27
Q

Who needs to be informed if a patient has visual problems or seizures?

A

DVLA

28
Q

What treatments can be used for patients who have brain tumours unsuitable for surgery?

A

Radiotherapy

Chemotherapy

29
Q

Which grades of astrocytomas are classed as

a) malignant
b) benign
c) ‘low grade’?

A

a) III and IV
b) I
c) II

30
Q

Which cells produce myelin in the CNS?

A

Oligodendrocytes

31
Q

Oligodendrocyte tumours are susceptible to which treatment?

A

Chemotherapy

32
Q

Which tumour affects the myelin-producing cells surrounding CN VIII?

A

Vestibular schwannoma / Acoustic neuroma

33
Q

What are the symptoms caused by vestibular schwannomas?

A

Sensorineural hearing loss

Tinnitus

34
Q

If a patient has bilateral vestibular schwannomas, what should you suspect them of having?

A

Neurofibromatosis Type 2

Neurology Week 3 2018/19 (10 decks)

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