2: Intracranial neoplasms Flashcards
Which eye sign should be checked for on fundoscopy of someone with a headache?
Papilloedema
indicates CN II compression due to raised ICP, will progress to visual loss if untreated
Children tend to get ___tentorial tumours.
What gait do they present with?
infratentorial tumours
ataxic gait, tiptoeing
Brain tumours are common in which population?
Children
Second most common cancer after leukaemia
What are some of the symptoms of an intracranial tumour?
Headache
N&V
Seizures
Visual disturbance
Sensory / motor problems
Neurological deficit - changes in behaviour, personality, language
What is the Monro Kellie hypothesis?
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)
What happens to the brain if intracranial pressure increases?
Compression (causing neurological symptoms)
Extreme compression causes herniation
What is Cushing’s triad of signs following a severe brain herniation?
Why is it important?
Hypertension
Bradycardia
Irregular breathing
If untreated, patient will die imminently
What are red flag headache symptoms which may indicate a brain tumour?
New onset in patients aged > 55
Early morning headache
Headaches which interrupt sleep
Unexpected weight loss
Hx malignancy, immunosuppression
Does the brain have any pain receptors?
No
Do the meninges have any pain receptors?
Yes
e.g photophobia, which is caused by meningeal irritation
What are some examples of neurological deficit caused by brain tumours?
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”
Which systems must you examine in someone presenting with new onset neurological symptoms?
Full neurological examination
Eyes - i.e direct fundoscopy, visual acuity, fields, eye movements…
What do MRI scans pick up compared to CT scans?
Blood
plus they’re higher definition
What are three important investigations for intracranial tumours?
CT/MRI scan
Biopsy
Fundoscopy
Cancers of astrocytes are ___ depending on their severity.
graded
Grade I astrocyte tumours mostly affect which population?
Children
All astrocytomas graded II or above are ___.
malignant
How are grade I astrocytomas treated?
Surgery
What do grade I astrocytomas look like on MRI?
Solid
Enhance well (glow white)
What condition may brain tumours cause if they block the flow of CSF around the ventricles?
Hydrocephalus
Patients with low grade (II) astrocytomas tend to present with which symptom?
Seizures
Do low grade (II) astrocytomas enhance well on injection of contrast?
No
Low grade (I.e II and III) astrocytomas will ___ over time unless they are removed surgically.
grow
How are grade II astrocytomas treated?
Surgery
+/- chemo/radiotherapy, often combined
