5. Neuroparthology 1

Question 1

Benign meaning

Answer 1

Non-invasive

Question 2

Brain tumours are normally…

Answer 2

2ndary
Metastatic

From:
Breast, melanoma, lung
Kindey, gut,
Lymphoma/leukaemia

Question 3

Effect of brain tumour

Answer 3

Normally NIL

SoL:
–> Fits, visual impairment, drowsiness, behavioural, change, increase ICP, headache

Haemorrhage

Question 4

Lung cancer type?

Answer 4

Small cell undifferentiated (aggressive
Squamous
Adeno

Question 5

What are the normal constituents of intracraniel system?

Answer 5

• Brain
• Linings – arachnoid
membrane
• Pituitary
• Peripheral nerve
elements VIII cranial nerve

Question 6

Commonest brain tumours, primary + secondary and from the nerves?

Answer 6

Secondary:
Malignant tumour is metastatic

Primary:
Intracranial primary neoplasma is meningoma (about 2/3)
Primary neoplasms that are on a malignant spectrum are gliomas (about 2/3)

From nerves:
intracranial peripheral nerve tumour is acoustic Schwannoma (acoustic neuroma) less than 10%

Question 7

Meningioma:
Cause?
Location?
Character?
Presentation?
Treatment?

Answer 7

Cause:
Sporadic
Post-irradiation
Part of NF2

Location: Sites of arachnoid

Characteristics:
• Grossly, well demarcated
• Slowly growing
• Not invasive, but erosive and compressive

Presentation:
Fits
Drowsiness
Headaches

Treatment:
Surgical removal

Question 8

Normal constituents of glia in CNS?

Answer 8

Glioma:
• Neurons
• Astrocytes
• Microglia
• Oligodendroglia
• Choroid plexus
• Ependyma

Question 9

Examples of gliomas?

Answer 9

• Oligodendroglioma
• Astrocytomas
• Ependymoma
• Choroid plexus tumours
• Medulloblastoma and PNET

Question 10

Astrocytoma grading

Answer 10

WHO grading
• I Localised
• II Diffuse
• III Anaplastic astrocytoma
• IV Glioblastoma multiforme

Higher grade means more mitosis and multiplication

None are completely benign

Grading informs prognosis and treatment

Question 11

Grade of oligodendroglioma?

Answer 11

Low

Question 12

Grade of anaplastic astrocytoma?

Answer 12

Gadde III

Question 13

PNET?

Answer 13

Primitive neuroectodermal tumours

E.g. Medulloblastoma highly malignant in children

Question 14

Cause of brain tumour progression

Answer 14

Accumulation of abnormal genetic pathology such as..
• BRAF Fusion Gene and V600E point mutations (astrocytoma)
• Molecularanalysisof LOH1p/19q in astrocytomas and oligodendrogliomas
• IDH1/2mutations better outlook

Used for diagnosis and prognosis

Question 15

What techniques are used to prediction of brain tumour progression vs prognosis?

Answer 15

• Methylation of MGMT
in malignant gliomas
• Molecular analysisof EGFR amplification and EGFRvIII mutations in GBM

Question 16

What are the common peripheral nerve tumours?

Answer 16

• Neural – neuroblastoma, ganglioneuroma
• Schwannoma or neurofibroma
• Remember Cranial nerve VIII: acoustic nerve. Presents are progressive, unilateral hearing loss

Question 17

Schwannoma presentation?

Answer 17

Lump to feel
Benign
Pain due to nerve compression

Can be potentially excised without damaging nerve

Question 18

Presentation of neurofibroma and issues?

Answer 18

Pain and nerve compression
Can have bone deformation is nerve goes through bone

Cannot be easily removed as tumour is within nerve

Question 19

Dominance of neurofibroma type 1?

Answer 19

AD

50% spontaneous

Question 20

MISME?

Answer 20

Multiple Inherited Schwannomas,

Meningiomas and Ependymomas

Question 21

Neurofibromatosis type 2, examples

Answer 21

MIME: Multiple Inherited Schwannomas Meningiomas and Ependymomas

Bilateral acoustic schannoma and Marlin NF2

Question 22

Location of neurofibromatosis type 1 effect

Answer 22

NF1 is caused by a genetic mutation, which is a permanent change in the DNA sequence that makes up a gene. As a result, the growth of nerve tissue isn’t properly controlled.

In most cases of NF1 the SKIN is affected, causing symptoms such as:
1. pale, coffee-coloured patches (café au lait spots)
soft
2. Non-cancerous bumps on or under the skin (neurofibromas)

Certain health problems are often associated with NF1, such as learning difficulties

Question 23

Location of neurofibromatosis type 2 effect

Answer 23

Almost everyone with NF2 develops tumours on the nerves responsible for hearing and balance. These typically cause symptoms such as:
gradual hearing loss, that usually gets worse over time
ringing or buzzing in the ears (tinnitus)
balance problems, particularly when moving in the dark or walking on uneven ground

Tumours can also develop inside the brain or spinal cord, or the nerves to the arms and legs. This can cause symptoms such as weakness in the arms and legs, and persistent headaches.