2.2 Space occupying lesions + brain tumours

Question 1

what are space occupying lesions

Answer 1

anything abnormal that occupies a space within the skull, literally anything including:
- haemorrhages
- meningitis purulent exudate
- tumour
- cerebral oedema
- hydrocephalus incr CSF

Question 2

complications of space occupying lesions

Answer 2

complications can be due to what the space occupying lesion itself includes:

• herniation
• ischemia and infarction due to vascular compression

Question 3

how is CSF reabsorbed at arachnoid granulations

Answer 3

arachnoid granulations are pressure dependent one way valves wich open when ICP is 3-5mmHg greater than dural venous sinus

Question 4

causes of communicating hydrocephalus 3

Answer 4

haemorrhage
post infection
idiopathuc

Question 5

causes of non communicating 4

Answer 5

cerebral aqueduct stenosis
tumours
infection
malformation

Question 6

on a ct what is the first sign of hydrocephalus

Answer 6

diltation of temporal horns of lateral ventricles, normally they should be barely visible - looks liek chromosomes

Question 7

clinical features of hydrocephalus 4

Answer 7

headaches
papiloedema
cushings
focal neurological defects

Question 8

what is cushsings in hydrocephalus

Answer 8

bradycardia
bradyrespirations
hypertension

Question 9

treatment of hydrocephalus 3

Answer 9

external ventricular drain
remove obstruction

if permanent obstructure insert ventriculoperitoneal shunt

Question 10

what is a ventriculoperitoneal shunt

Answer 10

it is a catheter placed in the lateral ventricle which runs down into the peritoneal cavity where the CSF is reabsorbed

Question 11

characteristics of benign tumours 3

Answer 11

contained in fibrous capsule

well differentiated

slow growing

Question 12

characteristics of malignant tumours 5

Answer 12

not contained, poor margins

poorly differentiated

metatastatic

commonly necrosis and haemorrhage

grow fast

Question 13

why do tumours metastasise to the brain

Answer 13

because its one of the areas with the largest blood supplies, this is where tumours will metastasise to

Question 14

primary vs secondary tumour

Answer 14

primary: tumour at the site of origin
secondary: metastasised will have features of original

Question 15

prefix adeno meaning in tumour nomenlcature

Answer 15

glandular

Question 16

prefix leiomyo meaning in tumour nomenlcature

Answer 16

smooth muscle

Question 17

prefix osteo meaning in tumour nomenlcature

Answer 17

bone

Question 18

suffix oma meaning in tumour nomenlcature

Answer 18

benign

Question 19

suffix carcinoma meaning in tumour nomenlcature 3

Answer 19

malignant

epithelial origin w tissue derived from endoderm or ectoderm

Question 20

suffix sarcoma meaning in tumour nomenlcature
*think sarcomere and assoicated

Answer 20

malignant

bone, cartilage and muscle origin
tissue derived from mesoderm

Question 21

stage of a tumour meaning

Answer 21

degree of spread

Question 22

grade of a tumour meaning

Answer 22

histological analysis the extent of differentiation

Question 23

how many stages are there and what are they based off 3

Answer 23

there are four stages they are based off:

Tumour size
Metastasis
Number of nodes it has affected - depth of invasion

Question 24

grade 1 and grade 2 of a tumour characteristics 3

Answer 24

mature
little mitotic activity
less atypia

Question 25

grade 3 and grade 4

Answer 25

dont resemble mature cells more mitotic activity geonomic instability cytological atypia

Question 26

3 common types of brain tumours

Answer 26

astrocytomas oligodendroglioma ependymoma

Question 27

what is the most common type of brain tumour

Answer 27

astrocytoma

Question 28

three grades of astrocytoma

Answer 28

diffuse astrocytoma anaplastic astrocytoma glioblastoma

Question 29

what are the different grades of tumours and what are the characteristics of each HAR

Answer 29

three relevant grades: G2, G3, G4 G2 = atypia alone G3 = atypia with mitosis G4 = atypia, mitosis, necrosis and endothelial proliferation

Question 30

Diffuse astrocytoma: Grade, histology, survival

Answer 30

Grade 2 slow growing, with atypia survival 6-8yrs

Question 31

anaplastic astrocytoma grade, feature

Answer 31

Grade 3 abnormal mitoses, atypia intermediate stage before glioblastoma

Question 32

glioblastoma grade and features which are 5

Answer 32

grade four rapid growth, high mitoses, high atypia, necrotic core, microvascular proliferation

Question 33

what can glioblastomas be further classified into

Answer 33

primary and secondary glioblastomas

Question 34

primary glioblatomas 2

Answer 34

rapid progression with out previous low grade tumour typically older patients get

Question 35

secondary glioblastomas

Answer 35

previous low grade tumour which transitioned to higher grade tumour due to extra mutations typically in younger patients

Question 36

oligodendrogliomas 4 complicated points (commone clinical feature, common feature on imaging, diagnostic requirement, grade)

Answer 36

commonly a long history of seizures - due to myeline dysregulation calcification common on imaging diagnostic requirement is loss of chromosome arms and idh mutation mainly grade 2

Question 37

ependymoma 3

Answer 37

solid papillary mass arising from ependymal cells in children this occurs most commonly in fourth ventricle in adults occurs most commonly in central canal

Question 38

what type of headache is associated with brain tumours

Answer 38

morning headaches, because they are a space occupying lesion they result in raised icp headaches also worse when coughing or straining

Question 39

what is adjunctive brain therapy in brain tumours

Answer 39

treatments given after surgery; chemotherapy and radiotherapy to try and reduce the remaining tumours growth