4. Space occupying lesion, raised ICP and brain tumours Flashcards

1
Q

What is the different between primary and secondary brain tumours

A

primary usually arise from the intracranial structures such as meninges (meningioma) or glial cells (gliomas or astrocytomas)

Secondary arise from primary tumours usually arising from bronchus, breast, stomach, prostate, thyroid or kidneys

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2
Q

Space occupying lesions in the brain:

what infections can cause SOL

A

brain abscess
subdural empyema
granuloma (eg TB)
Parasitic

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3
Q

Space occupying lesions in the brain:

what vascular causes can cause SOL

A

any haemorrhage (extradural, subdural, subarachnoid, parenchymal

cavernoma (cluster of abnormal blood vessels) or vascular malformations

brain infarction (stroke)

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4
Q

what may cause hydrocephalus (accumulation of CSF)

A

tumours, cysts, intraventricular haemorrhage

Meningitis, sub-arachnoid haemorrhage

choroid plexus papilloma (rare)

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5
Q

Presentation of tumours, note the symptoms are due to raised ICP

What are the general common symptoms

A

headache, vomiting, blurred vision, deterioration of consciousness levels

Bradycardia, hypertension, Papilloedema

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6
Q

If a patient has a tumour in the frontal lobe, what symptoms would they present with

A

weakness, dysphasia, personality changes, dementia

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7
Q

If a patient has a tumour in the parietal lobe, what symptoms would they present with

A

sensory symptoms, dressing apraxia, visual field defects

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8
Q

If a patient has a tumour in the temporal lobe, what symptoms would they present with

A

dysphasia and visual field defects

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9
Q

If a patient has a tumour in the occipital lobe, what symptoms would they present with

A

visual field issues

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10
Q

If a patient has a tumour in the posterior fossa, what symptoms would they present with

A

dysmetria (lack of co-ordination), gait ataxia, cranial nerve palsy, tremors, nystagmus

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11
Q

Symptoms of neurological deficit is due to the compression or damage of adjacent structures. What is pronator drift and what does it show

A

when pt raises both arms horizontally with palms facing upwards, when they close their eyes one arm lowers or pronates (normally both should stay up) which indicates paresis

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12
Q

If the brain is irritated what kind of seizures can occur

A

focal seizure
general tonic clonic seizure
irritation of meninges can cause headache

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13
Q

What is the normal ICP in adults and at what point does it become pathological

A

less than 15mmHg in adults

pathological is when it is above 20 mmgHg

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14
Q

how is ICP different in children compared to adults

A

children have lower ICP and can be negative in newborn

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15
Q

how does ICP change when you sneeze or cough

A

it can go up to 75 at times

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16
Q

what does Papilloedema look like

A

edges of the optic disc are blurred due to swelling and haemorrhage changes around the disc margins

17
Q

What can cause increased in ICP

A

increase in brain/tissue/mass volume (such as SOL or cerebral oedema)
increased in CSF volume
increase in blood volume (due to raised arterial PCO2, venous obstruction, raised temperature)

18
Q

Cerebral blood flow is dependant on cerebral perfusion pressure (CPP) which is equal to what

A

mean arterial pressure = ICP

19
Q

In the treatment of increased ICP what measures can you put in place to manage it acutely

A

head up tilt (30-45 degrees) to promote venous outflow

keep neck straight so not to obstruct jugular venous outflow

avoid hypotension to maintain cerebral blood flow (can use vasopressors)

maintain adequate sedation to reduce metabolic demands

maintain normal PCO2 as raised PCO2 causes cerebral vasodilation and increases cerebral blood volume

20
Q

What therapy can be prescribed to treated ICP

A

mannitol (it is an osmotic diuretic that reduces brain volume )
hyperventilation
barbiturate therapy (thiopentone, phenobarbitone which reduces brain metabolism and cerebral blood flow)

21
Q

Which medication to treat ICP would need continuous EEG monitoring as it reduces brain metabolism and cerebral blood flow

A

barbiturate therapy

22
Q

what specialist measures can be used to treat raised ICP

A

removal of the SOL
decompressive craniectomy to remove the rigid confines of the skull (craniectomy alone or by opening the dura in addition)

23
Q

if a patient was to present with personality and behavioural changes then which area of the brain would a tumour be indicated in

A

frontal lobe

24
Q

what is the key finding that would indicate raised ICP

A

Papilloedema in a fundoscopy

25
Q

What can cause raised ICP

A
  • Brain tumours
  • Intracranial haemorrhage
  • Idiopathic intracranial hypertension
  • Abscesses or infection
26
Q

Concerning features of a headache that should prompt further examination and investigate would be if the headache is ………

A
  • Constant
  • Nocturnal
  • Worse on waking
  • Worse on coughing, straining or bending forward
  • associated with Vomiting
27
Q

what would be some other presenting features of raised ICP aside from the very concerning ones

A
  • Altered mental state
  • Visual field defects
  • Seizures (particularly focal)
  • Unilateral ptosis
  • Third and sixth nerve palsies
  • Papilloedema (on fundoscopy)
28
Q

what actually is Papilloedema and what causes it

A

swelling of the optic disk secondary to raised intracranial pressure
sheath around the optic nerve is connected with the subarachnoid space therefore when CSF under high pressure it flows into the optic nerve sheath

29
Q

what fundoscopic changes would you see in someone presenting with Papilloedema

A
  • Blurring of the optic disc margin
  • Elevated optic disc (look for the way the retinal vessels flow across the disc to see the elevation)
  • Loss of venous pulsation
  • Engorged retinal veins
  • Haemorrhages around optic disc
  • Paton’s lines which are creases in the retina around the optic disc
30
Q

when looking for elevation of the optic disk in patients with papillodema, what can the blood vessels tell yo about the disk

A

the retinal vessels are able to flow straight across a flat disk whereas they will curve over a raised disc

31
Q

what are the common cancers that metastases to the brain

A

lung
breast
colorectal
prostate

32
Q

what are gliomas and name the three types (from most too least malignant)

A

tumours of the glial cells
• Astrocytoma (glioblastoma multiforme is the most common)
• Oligodendroglioma
• Ependymoma

33
Q

what are meningiomas

A

tumours growing from the cells of the meninges in the brain and spinal cord
-usually benign but can lead to increased ICP and neurological symptoms

34
Q

what common symptom does a pituitary tumour cause

A

bitemporal hemianopia as it presses on the optic chasm

35
Q

What is acoustic neuroma aka vestibular schwannoma

A

tumours of the scwann cells surrounding the auditory nerve

occur around the cerebellopontin angle and sometimes referred to as cerebellopontine angle tumours

36
Q

what are the common symptoms of an acoustic neuroma

A

hearing loss
tinnitus
balance problems

37
Q

what are the main management options for brain tumours

A

palliative care
chemotherapy
radiotherapy
surgery

38
Q

what is the difference between CT and MRI

A

CT is X ray based whereas MRI uses magnetic waves

39
Q

which type of scan provides better spatial resolution of soft tissue lesions

A

MRI