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Neuro II > 31A Adult Brain Tumors > Flashcards

31A Adult Brain Tumors Flashcards

1
Q

What is the plateau wave phenomenon?

A
  1. with tumor growth, cranial pressure incr
  2. eventually, small changes in MAP (due to volume or pressure) = large incr in ICP
  3. this will affect perf –> focal deficits, MS changes, seizures, etc
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2
Q

General signs/symptoms of CNS tumors?

A
  1. HA (incr ICP)
  2. vomiting (+/- nausea)
  3. MS changes (depr, apathy, irritability)
  4. papilledema (MC in kids, young adults)
  5. seizures
  6. focal deficits
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3
Q

What HA symptoms should prompt tumor concerns?

A
  • new onset at any age
  • worse on wakening, gone in ~hr
  • change in character or severity (if chronic)
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4
Q

What vomiting symptoms should prompt tumor concerns?

A

immediately follows HA onset

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5
Q

What causes the signs/symptoms associated with CNS tumors?

A
  1. invasion of neural or vasc structures
  2. compression of adjacent neural or vasc structures
  3. Obstr of CNS pathways –> hydrocephalus (incr ICP)
  4. herniation from mass effect
  5. cerebral hypoperfusion (incr ICP)
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6
Q

Involvement and pressure on blood vessels can result in:

A

hemorrhage or CVA

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7
Q

Subfalcine herniation of cingulate gyrus may compress:

A

anterior cerebral artery and CVA

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8
Q

Diencephalic downward herniation can compress:

Symptoms?

A

upper brainstem

drowsiness + Horner’s

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9
Q

Uncal herniation causes:

A

ipsilateral oculomotor nerve palsy and contra or ipsilateral hemiparesis

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10
Q

Upward herniation through tentorium may cause:

A

ipsilateral oculomotor, Horner (mid position unreactive pupil) and contralateral hemiparesis

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11
Q

Tonsillar herniation causes:

A

BP changes, weakness, respiratory disturbance, weakness and Horner syndrome

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12
Q

Study of choice when tumor is suspected?

A

MRI

but CT is more helpful in defining tumor pathology

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13
Q

In T2 MRI, (edema/tumor) spares the cortex

A

edema

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14
Q

MC 1’ adult tumor?

A

gliomas

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15
Q

Subtypes of glioma?

A

astrocytoma, oligodendroglioma, ependymoma

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16
Q

Grade 1 glioma?
Grade 2?
Grade 3?
Grade 4?

A 
1 = juvenile pilocystic astrocytoma
2 = low grade astrocytoma
3 = anaplastic astrocytoma
4 = glioblastoma multiforme
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17
Q

MC type of glioma?

A

glioblastoma multiforme

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18
Q

Low-grade tumors are MC in:

High-grade tumors are MC in:

A

younger pts

>50 yo

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19
Q

Grade 1 Glioma:
Malignancy?
Histo?
Trx?

A

least malig and slow growing

non-infiltrative, ~nml

resection (likely curative)

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20
Q

Grade 2 Glioma:
Malignancy?
Histo?
Trx?

A

~ slow growing

more abn w/ Rosenthal fibers, can infiltrate

resection, but can recur–sometimes higher grade
(cure unlikely, but survival over many yrs)

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21
Q

Grade 3 Glioma:
Malignancy?
Histo?
Trx?

A

malignant, fast growing

abn cells, infiltrate adjacent tissue

resection, but tend to recur at higher grade
(cute unlikely, 2-3yr survival)

22
Q

Grade 4 Glioma:
Malignancy?
Histo?
Survival?

A

malignant, rapid growing

pseudopalisading pleomorphic appearance, widely infiltrating, neovasc with central necrosis

months

23
Q

Genetic factor associated with improved survival in oligodendroglioma?

A

1p and 19q deletions

24
Q

Epidemiology of meningiomas?

A

45 y/o F

25
Q

Meningiomas are derived from:

A

arachnoid membrane

26
Q

Locations of meningiomas?

A

convexity, parasagittal, optic sheath

27
Q

Prognosis of meningiomas?

A

Benign, resection often curative

28
Q

Histo of meningiomas?

A

spindle cells in whorled pattern, psammoma bodies

29
Q

Pituitary tumors are MC derived from:

A

ant pituitary

30
Q

Pituitary tumors are more likely to secrete hormones if:

A

<1cm

31
Q

Pituitary tumors signs/symptoms?

A

HA
endo dysf
visual defects
facial numbness

32
Q

What causes facial numbness associated with pituitary tumors?

A

invasion of cavernous sinus –> CNV compression

33
Q

What causes bitemporal hemianopsia associated with pituitary tumors?

A

compression of optic chiasm, starts in upper quad

34
Q

What causes unilateral blindness associated with pituitary tumors?

A

optic n compression

35
Q

What causes diplopia associated with pituitary tumors?

A

invasion of cavernous sinus –> CN III, IV, VI compression

36
Q

Origin of auditory neuroma?

A

Schwann cells surrounding vestibular portion of CNVII

37
Q

MC locations of auditory neuroma?

A

int auditory canal or cerebellopontine angle

38
Q

Epidemiology of auditory neuroma?

A

middle age (M=F)

39
Q

Prognosis of auditory neuroma?

A

benign, slow growing

40
Q

Signs/symptoms of auditory neuroma?

A

hearing loss, tinnitus, HA, dizziness, facial numbness or weakness

41
Q

Bil auditory neuromas =

A

neurofibromatosis type 2

42
Q

CNS lymphoma most commonly affects:

A

leptomeninges + deeper periventricular brain parenchyma

43
Q

CNS lymphoma trx:

A

steroids (oncolytic)

Methotrexate (crosses BBB)

44
Q

CNS lymphoma possible etiology?

A

EBV in ICH

45
Q

MC CNS tumor?

A

mets

46
Q

MC type of brain mets in males? In females?

A

lung CA

breast CA

47
Q

What type of cancer has the highest propensity to met to brain?

A

melanoma

48
Q

Prognosis of brain mets?

A

Untreated = 4wks
Steroids only = 8 wks
Other = up to 1yr

49
Q

Ddx of ring enhancing lesions?

A
  • mets
  • abscesses
  • CVA
  • high grade glioma
  • lymphoma
  • demyelination (open/inc)
50
Q

MC type of extradural spinal cord tumor?

A

met from breast, lung, prostate, renal CC, lymphoma, sarcoma

51
Q

MC type of intradural medullary spinal cord tumor in adults? In kids?

A

ependymoma

astrocytoma

Neuro II (18 decks)

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