31A Adult Brain Tumors Flashcards by Jennifer Watson

What is the plateau wave phenomenon?

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

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General signs/symptoms of CNS tumors?

HA (incr ICP)
vomiting (+/- nausea)
MS changes (depr, apathy, irritability)
papilledema (MC in kids, young adults)
seizures
focal deficits

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What HA symptoms should prompt tumor concerns?

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

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What vomiting symptoms should prompt tumor concerns?

immediately follows HA onset

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What causes the signs/symptoms associated with CNS tumors?

invasion of neural or vasc structures
compression of adjacent neural or vasc structures
Obstr of CNS pathways –> hydrocephalus (incr ICP)
herniation from mass effect
cerebral hypoperfusion (incr ICP)

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Involvement and pressure on blood vessels can result in:

hemorrhage or CVA

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Subfalcine herniation of cingulate gyrus may compress:

anterior cerebral artery and CVA

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Diencephalic downward herniation can compress:

Symptoms?

upper brainstem

drowsiness + Horner’s

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Uncal herniation causes:

ipsilateral oculomotor nerve palsy and contra or ipsilateral hemiparesis

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Upward herniation through tentorium may cause:

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

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Tonsillar herniation causes:

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

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Study of choice when tumor is suspected?

MRI

but CT is more helpful in defining tumor pathology

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

edema

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MC 1’ adult tumor?

gliomas

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Subtypes of glioma?

astrocytoma, oligodendroglioma, ependymoma

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

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

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MC type of glioma?

glioblastoma multiforme

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Low-grade tumors are MC in:

High-grade tumors are MC in:

younger pts

>50 yo

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Grade 1 Glioma:
Malignancy?
Histo?
Trx?

least malig and slow growing

non-infiltrative, ~nml

resection (likely curative)

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Grade 2 Glioma:
Malignancy?
Histo?
Trx?

~ 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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Grade 3 Glioma:
Malignancy?
Histo?
Trx?

malignant, fast growing

abn cells, infiltrate adjacent tissue

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

Grade 4 Glioma:
Malignancy?
Histo?
Survival?

malignant, rapid growing

pseudopalisading pleomorphic appearance, widely infiltrating, neovasc with central necrosis

months

Genetic factor associated with improved survival in oligodendroglioma?

1p and 19q deletions

Epidemiology of meningiomas?

45 y/o F

Meningiomas are derived from:

arachnoid membrane

Locations of meningiomas?

convexity, parasagittal, optic sheath

Prognosis of meningiomas?

Benign, resection often curative

Histo of meningiomas?

spindle cells in whorled pattern, psammoma bodies

Pituitary tumors are MC derived from:

ant pituitary

Pituitary tumors are more likely to secrete hormones if:

<1cm

Pituitary tumors signs/symptoms?

HA endo dysf visual defects facial numbness

What causes facial numbness associated with pituitary tumors?

invasion of cavernous sinus --> CNV compression

What causes bitemporal hemianopsia associated with pituitary tumors?

compression of optic chiasm, starts in upper quad

What causes unilateral blindness associated with pituitary tumors?

optic n compression

What causes diplopia associated with pituitary tumors?

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

Origin of auditory neuroma?

Schwann cells surrounding vestibular portion of CNVII

MC locations of auditory neuroma?

int auditory canal or cerebellopontine angle

Epidemiology of auditory neuroma?

middle age (M=F)

Prognosis of auditory neuroma?

benign, slow growing

Signs/symptoms of auditory neuroma?

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

Bil auditory neuromas =

neurofibromatosis type 2

CNS lymphoma most commonly affects:

leptomeninges + deeper periventricular brain parenchyma

CNS lymphoma trx:

steroids (oncolytic) | Methotrexate (crosses BBB)

CNS lymphoma possible etiology?

EBV in ICH

MC CNS tumor?

mets

MC type of brain mets in males? In females?

lung CA | breast CA

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

melanoma

Prognosis of brain mets?

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

Ddx of ring enhancing lesions?

- mets - abscesses - CVA - high grade glioma - lymphoma - demyelination (open/inc)

MC type of extradural spinal cord tumor?

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

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

ependymoma | astrocytoma