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Neuro Block 2 > Adult Tumors of the CNS (6) > Flashcards

Adult Tumors of the CNS (6) Flashcards

0
Q

What are three types of Glial cell tumors?

A

aka Astrocytic

  1. Glioma
  2. Ependymoma
  3. Oligodendroglioma
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1
Q

What is a ganglioglioma?

A

Mixed tumor containing both glial cell and neuronal cell components

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2
Q

What are two types of nerve cell tumors?

A
  1. Schwannoma

2. Neurofibroma

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3
Q

What is a hemangioblastoma?

A

tumor arising from intracranial blood vessels

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4
Q

What type of cells do meningiomas arise from?

A

arachnid cap cells

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5
Q

What are the two most common types of primary brain tumors in adults?

A
  1. Infiltrative astrocytoma (42%)

2. Glioblastoma Multiforme (GBM; 40%)

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6
Q

Gliomas, Pituitary tumors, and Lymphomas are typically found where in the CNS?

A

Intracranially (intra-axially)–> these are slightly more common than extra-cranial CNS tumors(ones outside the brain parenchyma proper)

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7
Q

Meningiomas and Acoustic neuromas are found where (in broad general terms)

A

Extrcranially (extr-axial tumors)

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8
Q

Outside of genetic syndromes that confer predisposition, what are 2 definitive risk factors for the development of a brain primary tumor?

A
  1. Ionizing radiation

2. Immunosuppression (Hx of chemotherapy or AIDS)

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9
Q

What are 5 genetic syndromes that increase risk of primary brain malignancy?

A
  1. Li-Fraumeni Syndrome
  2. Tuberous Sclerosis
  3. Neurofibromatosis type 1 and type 2
  4. Multiple Endocrine Neoplasia Type 1 (MEN 1)
  5. Von Hippel-Lindau disease
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10
Q

How is Cerebral perfusion pressure (CPP) calculated?

A

Mean arterial pressure - intracranial pressure

MAP - ICP

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11
Q

What is the plateau wave phenomenon? What does it mean clinically?

A

With tumor growth, intracranial pressure will remain relatively constant until brain compliance threshold is reached–> at this point, very small changes in volume (like from a tumor) will cause very large increases in intracranial pressure.
*intermittent increase in intracranial pressure may exceed cerebral perfusion pressure (these intermittent increases are the pressure waves) causing ischemia–> multiple clinical symptoms

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12
Q

What are 3 possible clinical symptoms that may be caused by the plateau wave phenomenon?

A
  1. Focal weakness
  2. Numbness
  3. Mental status change (possibly to seizure-like activity)
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13
Q

What characteristic feature is often noted about headaches due to intracranial tumors?

A

Often the headaches will be worse when laying down–> worse in the morning when pt awakes then goes away or decreases in intensity in about an hour

*change in character or severity of headaches in a chronic headache patient should be regarded with clinical suspicion for brain tumor as well

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14
Q

Vomiting at what time of day or following what can be indicative of possible CNS tumor?

A

Vomiting in the morning (after waking up) or immediately following an acute onset headache–> both causes are due to increased ICP

-vomiting is a more common symptom in children w/ CNS tumor compared to adults though

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15
Q

What psych symptoms than headache and vomiting may be seen due to CNS tumors

A

Mental status changes (depression, irritability, apathy)–> deficits if more eloquent brain structures impaired by compression or ischemia

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16
Q

What are three other general types of symptoms seen in CNS tumors, outside of HA, vomiting, mental status changes?

A
  1. Papilledema
  2. Seizures
  3. Focal neurological deficits (weakness, paresthesias, visual impairments, personality changes)
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17
Q

What type of hydrocephalus may be caused by CNS tumors? Waht characteristic sign might this cause to be evident?

A

Noncommunicating (obstructive) hydrocephalus–> may cause “sundown” sign which is paralysis of upward gaze, so eyes are always pointed a little down

Sunset sign moe commonly seen in children

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18
Q

Other than hydrocephalus, what are 3 causes of the signs/symptoms seen in CNS tumors?

A
  1. Invasion/ compression of neurovascular structures
  2. Herniation due to mass effect
  3. Cerebral hypoperfusion from increased ICP
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19
Q

Herniation of the cingulate gyrus below the falx tentorium may compress what artery?

A

Anterior cerebral artery

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20
Q

Cerebellar tonsillar herniation can cause what main two changes?

A
  1. Cardiorespiratory arrest
  2. BP changes
    * Coma and death may occur if these herniations compress the brain stem
    (possibly weakness and Horner, according to notes; this guy thinks horner is caused by it all)
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21
Q

What is the study of choice for a suspected CNS tumor?

A

MRI with and without contrast

is superior to CT in differentiating tumors from other lesion (like vascular malformations, etc)

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22
Q

What is a feature of CNS tumor-caused neurological symptoms compared to issues like stroke, migraine, seizure?

A

Neuro deficits will usually be much more gradually progressive in tumors compared to the quick onset of deficits in those issues

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23
Q

In a T1 weighted MRI scan, how do tumors/CSF/water appear? What about in a T2 weighted scan.

A

T1= hypointense (dark)–> injected contrast can leak across disrupted BBB found within/ nearby tumors

T2= hyperintense (bright)–> can differentiate edema from infiltrating tumor; will see hyperintense areas in the cortex, edema will always spare the cortex

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24
What is the most common primary malignant brain tumor in adults?
Glioma--> specifically Astrocytomas are most common (70% of all neuroglial tumors) This includes Glioblastoma multiforme (is a stage IV astrocytoma) *4th - 6th decade
25
What part of the brain are most primary brain tumors found in adults? (above what)
above tentorium cerebelli
26
In what lobe are astrocytomas most commonly found in adults?
Frontal lobe--->may cross the corpus callosum, forming "butterfly glioma"
27
In what pt population are most high grade (III and IV) astrocytomas foud? low grade?
High grade -->(includes Glioblastoma multiforme) more commonly seen in pts over 50 Low grade--> in those under 50 (these may be positive for mutated isoforms of citrate dehydrogenase); generally are slow grawing and do not produce mass effect
28
What is a histological characteristic of Stage IV astrocytoma, or glioblastoma multiforme?
Generally have a necrotic center, due to rapid growth that outpaces blood supply ("pseudopalisading" pleomorphic tumor) --> also have evidence of angiogenesis (thus will leak de via the immature vessels on MRI)
29
What are the two main Rx symptomatic tx for glioma?
1. Steroids --> reduces edema and improves intracranial pressure; dramatic improvement of neurologic symptoms, but temporary 2. anticonvulsants--> ONLY if seizure has occurred; use levitiracem- has no drug interactions and no CYP metabolism
30
What is as adjuvant to surgery (which improves ICP and seizures; prolongs survival in resectable tumors)?
Radiotherapy
31
3 risks of radiation therapy?
1. Cognitive decline 2. Stroke 3. Secondary malignancy
32
What chemotherapeutic agent is DOC for glioma/ astrocytoma?
Temozolomide--> alkylating agent, adds 3 mo to mean survival * esp effective in pt with inactive enzyme MGMT (O6-methyl guanine DNA methyltransferase, which is a DNA repair enzyme; no improvement over radiation alone if enzyme is active
33
What biologic agent is FDA approved for tx of gliomas that works by preventing angiogenesis?
Bevacizumab--> Ab to VEGF
34
What is the most common benign brain primary tumor in adults (also the 2nd MC brain primary overall)? Where are they found?
Meningioma--> are extra-axial (outside the brain parenchyma tumors) *Most often appear in convexities of the hemispheres (near surfaces of brain) and parasagital region
35
In what age and sex are menigiomas most commonly found?
45 is peak incidence; more common in Women
36
What feature other than diffuse enhancement do meningiomas exhibit on MRI?
Dural Tail--> means they are attached to the dura mater
37
What is the characteristic microscopic finding for meningiomas?
Spindle-shaped cells arranged in whorls--> have psomomma bodies (calcium)
38
When do menigiomas need surgery and radiation?
When over 3 cm = small, low grade tumors usually have excellent prognosis with surgical resection alone
39
What is the 3rd MC type of brain primary tumor? Where most commonly derived from?
Pituitary tumor (10-15% of all brain primary) *MC derived from the anterior pituitary
40
Are microadenomas or macroadenomas most often hormone-secreting?
Microadenomas (less than 1 cm) Macroadenomas (over 1 cm) typically get large enough to cause compression and resulting hypofunction of pituitary or compression of pituitary stalk
41
What is the most common specific type of pituitary tumor?
Prolactinoma--> can be medically managed for the most part with dopamine agonists (bromocriptine or pergolide)
42
What is a common presenting symptom of a pituitary tumor, other than headache and endocrine symptoms?
Bitemporal hemianopsia *also may have diplopia or facial numbness (compression of CN V)
43
What are to useful tests to Dx a pituitary tumor?
1. MRI | 2. Serum hormone levels
44
What is the name for a tumor originating from Scwann cells? Which nerve do they surround?
Acoustic neuroma or Vestibular schwannoma--> arise form the vestibular portion of CN VIII
45
What place are Schwannomas found typically?
Cerebellopontine angle | sometimes in the internal auditory canal also
46
What is the common sex/ age epidemiology for Schwannomas?
Midle aged; male and females in equal proportions
47
Other than headache and dizziness, what are 3 common presenting symptoms/ signs of a Schwannoma?
1. Tinnitus 2. Hearing loss 3. Facial numbness or weakness (VII involvement due to compression in the internal auditory canal, where facial n also has some fibers)
48
Bilateral acoustic neuromas (Schwannomas) are pathognomic of what genetic condition?
Neurofibromatosis type 2
49
Primary CNS Lymphoma is typically what kind of lymphoma?
High-grade B-cell non-Hodgkin's lymphoma
50
What two places can CNS primary lymphoma affect?
leptomeninges or deep periventricular brain parenchyma
51
What chemo drug is used to treat CNS lymphoma?
Methotrexate--> can cross BBB Also use steriods
52
What two tests are done to Dx CNS lymphoma?
1. MRI --> show multiple uniformly enhancing masses with little to no edema 2. LP--> may show monoclonal population of B-cells in CSF
53
Why should steroids be avoided at first in CNS lymphoma?
They will cause rapid necrosis of the lymphomas, so will create a poor specimen for pathology to evaluate
54
What condition can predispose to CNS lymphoma in immunocompromised patients?
EBV infection
55
What is the most common type of brain met in men?
Small/ Non-small lung cancer (also prob most common overall)
56
What is the most common brain met in women?
Breast cancer
57
What type of cancer has the highest propensity to met to brain (not highest % or incidence, but propensity!)
Melanoma Colon CA and renal cell carcinoma frequently met to brain also
58
What is a finding on MRI that my indicate that you have a brain metastasis?
Significant edema out of proportion to the size of the nodules-> Multiple solid and ring enhancing lesions
59
What is treatment of choice with progressive intracranial disease du to brain mets?
Whole brain radiation
60
How long is survival for people with metasases of other CA to brain?
Anywhere from 1 mo. to a year = shitty
61
An incomplete, or open ring-enhancing lesion on MRI is commonly seen in what kind of condition?
Demyelinating condition
62
What are three common signs/ symptoms of a Spinal cord tumor?
1. Pain (most common finding) 2. Weakness plus UMN/LMN motor findings 3. Parathesias
63
What are the majority of extradural spinal tumors?
Most are metasases to the spinal cord--> breast, lung, prostate, renal call carcinoma
64
What are three common Intradural extramedullary spinal cord tumors?
1. Schwannmas 2. Neurofibromas 3. Meningiomas
65
What type of intradural, intramedullary tumor is most common in adults? Peds?
Adults --> Ependymoma Peds--> Astrocytoma *These are opposite to the brain tumor incidences for these age groups
66
How do meningiomas typically present?
Often asymptomatic; may be a cause of new-onset seizures *ass. w/ Neurofibromatosis type 2 and hx of radiation

Neuro Block 2 (11 decks)

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