(31A) Tumors of CNS Flashcards
tumors that originate from astrocytes/glial cells
glioma, ependymoma, oligiodendroglioma
tumors that are classified as “nerve tumors”
schwannoma and neurofibroma
What are the common types of cancers that metastasize to the CNS
Giant Retards Love Brain Mets
GI Renal Cell Carcinoma Lungs Breast Melanoma
origin of meningioma
arachnoid cap cells
definitive risk factors for CNS tumors
ionizing radition, genetic syndromes, immunosuppression
need to know hereditaty syndromes that are assc with brain tumors
??
What effect does an increase in intracranial volume have on intracranial pressure
pressure stays constant until the compliance threshold has been reached. at this point small changes in volume will cause a large increase in pressure
What is the plateau wave phenomenon?
?? cant find on google
general signs of CNS tumor vs focal signs of CNS tumor
general: headache, vomitting, mental status change
focal: papilledema, seizures, focal neuro deficits
specifically what characteristics of a headache are red flags for CNS tumor
worse upon awakening and improvement within 1 hr
specifically what characteristics of a vomitting are red flags for CNS tumor
vomit immediately after onset of headache (suggesting inc ICP)
_____ herniation compresses the ACA
subfalcine
____ herniation causes ipsilateral occulomotor N palsy and contra or ipsilateral hemiparesis
uncal
_____ herniation causes horners syndrome + contralateral hemiparesis
upward through tentorium
_____ herniation causes only horners syndrome
diencephalic
____ herniation causes changes in BP, RR, and horner’s
tonsillar
CT or MRI to detect CNS tumors
MRI
*CT is good for calcifications which can tell you the pathology of the tumor
T1 vs T2 weighted MRI scans
T1 contrast only gets in tumors
T2 edema and tumor appears hyperintense (edema spares the cortex though so anything in the cortex is tumor!)
What is the most common primary CNS tumor
glioma
___ grade gliomas are more commonly seen in children.
low
high grade = adults
low or high grade tumors are well differentated
low
*de-differentation is bad and = high grade
necrotic centers is a feature of a high or low grade glioma
high
surrounding edema is a feature of a high or low grade glioma
high
treatment that produces rapid but temporary improvement of glioma symptoms
STEROIDS–they reduce the swelling and restore BBB
seizures from a glioma are treated with (enzyme inducing or non-enzyme inducing) anti-seizure drugs
non-enzyme inducing
normal tissue and tumor recieve the same dose of radiiation
conventional/2D RT
chemo that is the std of care for glioma
temozolomide
genetic testing for ____ is needed before temozolomide
MGMT = need to have active MGMT to see response from temozolomide
drug used to treat gliomas that reoccured
bevacizumab
survival with a glioma is better if the pt has what genes?
MGMT active
isocitrate dehydrogenase mutation
1p and 19q deletion in oligiodendroglioma
meningioma is derived from
arachnoid cap cells
Who gets meningioma
45 yo; women
meningioma is a slow growing or aggressive tumor
slow growing
characteristic MRI finding for a meningioma
diffuse enhancement + dural tail
meningiomas are axial or extra axial tumors
extra axial
pituitary tumors are usually from the (ant or post) pit
anterior
microademomas are usually (non-functional or functional)
functional (make hormones)
macro are non-functional
signs/symp of pituitary tumors
headache, endocrine dysfunction, vidula defects (due to compression of optic chiasm)
treatment for PRLomas
DA agonists
origin of acoustic neuroma
schwann cells surrounding CN VIII > CN V > spinal radicles
Where do acoustic neuromas arise?
internal auditory meatus or cerebelloponitine angle
who gets acoustic neuromas
middle aged; M = F
acoustic neuromas are (slow growing or aggressive tumors_)
slow growing
how might an acustic neuroma present
hearing loss, tinnitus, headache, TN, ataxia
where do primary CNS lymphomas arise
leptomeninges and deeper periventricular brain parenchyma
how is primary CNY lymphoma different from the other adult primary CNS tumors?
multiple masses
Other than a scan how can PCNSL be diagnosed
LP contains monoclonal B cells in CSF
treatment for PCNSL
steroids but give AFTER biopsy otherwise you get a poor specimen for pathology (cells die quickly**
PCNSL is highly sensitive to
chemo and radiation therefore you can get CR and cure in younger pts
what is the treatment of choice for brain mets if there is progressive extracranial dz
whole brain radiation
diff dz for ring enhancing lesions on MRI
mets, CVA, demylenation, high grade glioma, lymphoma
signs and symptoms of a spinal cord tumor
pain, weakness, and parasthesis
most common extradural tumors of spinal cord
mets
most common intradural and extramedullary spinal cord tumors
schwannomas, neurofibromas, maningiomas
most common intradural and intramedullary spinal cord tumors
astocytomas (ped), ependymoma (adults), hemangioblastoma
