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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
Q

What is the most common primary malignant brain tumor in adults?

A

Glioma–> specifically Astrocytomas are most common (70% of all neuroglial tumors)
This includes Glioblastoma multiforme (is a stage IV astrocytoma)
*4th - 6th decade

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25
Q

What part of the brain are most primary brain tumors found in adults? (above what)

A

above tentorium cerebelli

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26
Q

In what lobe are astrocytomas most commonly found in adults?

A

Frontal lobe—>may cross the corpus callosum, forming “butterfly glioma”

27
Q

In what pt population are most high grade (III and IV) astrocytomas foud? low grade?

A

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
Q

What is a histological characteristic of Stage IV astrocytoma, or glioblastoma multiforme?

A

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
Q

What are the two main Rx symptomatic tx for glioma?

A
  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
Q

What is as adjuvant to surgery (which improves ICP and seizures; prolongs survival in resectable tumors)?

A

Radiotherapy

31
Q

3 risks of radiation therapy?

A
  1. Cognitive decline
  2. Stroke
  3. Secondary malignancy
32
Q

What chemotherapeutic agent is DOC for glioma/ astrocytoma?

A

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
Q

What biologic agent is FDA approved for tx of gliomas that works by preventing angiogenesis?

A

Bevacizumab–> Ab to VEGF

34
Q

What is the most common benign brain primary tumor in adults (also the 2nd MC brain primary overall)? Where are they found?

A

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
Q

In what age and sex are menigiomas most commonly found?

A

45 is peak incidence; more common in Women

36
Q

What feature other than diffuse enhancement do meningiomas exhibit on MRI?

A

Dural Tail–> means they are attached to the dura mater

37
Q

What is the characteristic microscopic finding for meningiomas?

A

Spindle-shaped cells arranged in whorls–> have psomomma bodies (calcium)

38
Q

When do menigiomas need surgery and radiation?

A

When over 3 cm = small, low grade tumors usually have excellent prognosis with surgical resection alone

39
Q

What is the 3rd MC type of brain primary tumor? Where most commonly derived from?

A

Pituitary tumor (10-15% of all brain primary)

*MC derived from the anterior pituitary

40
Q

Are microadenomas or macroadenomas most often hormone-secreting?

A

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
Q

What is the most common specific type of pituitary tumor?

A

Prolactinoma–> can be medically managed for the most part with dopamine agonists (bromocriptine or pergolide)

42
Q

What is a common presenting symptom of a pituitary tumor, other than headache and endocrine symptoms?

A

Bitemporal hemianopsia

*also may have diplopia or facial numbness (compression of CN V)

43
Q

What are to useful tests to Dx a pituitary tumor?

A
  1. MRI

2. Serum hormone levels

44
Q

What is the name for a tumor originating from Scwann cells? Which nerve do they surround?

A

Acoustic neuroma or Vestibular schwannoma–> arise form the vestibular portion of CN VIII

45
Q

What place are Schwannomas found typically?

A

Cerebellopontine angle

sometimes in the internal auditory canal also

46
Q

What is the common sex/ age epidemiology for Schwannomas?

A

Midle aged; male and females in equal proportions

47
Q

Other than headache and dizziness, what are 3 common presenting symptoms/ signs of a Schwannoma?

A
  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
Q

Bilateral acoustic neuromas (Schwannomas) are pathognomic of what genetic condition?

A

Neurofibromatosis type 2

49
Q

Primary CNS Lymphoma is typically what kind of lymphoma?

A

High-grade B-cell non-Hodgkin’s lymphoma

50
Q

What two places can CNS primary lymphoma affect?

A

leptomeninges or deep periventricular brain parenchyma

51
Q

What chemo drug is used to treat CNS lymphoma?

A

Methotrexate–> can cross BBB

Also use steriods

52
Q

What two tests are done to Dx CNS lymphoma?

A
  1. MRI –> show multiple uniformly enhancing masses with little to no edema
  2. LP–> may show monoclonal population of B-cells in CSF
53
Q

Why should steroids be avoided at first in CNS lymphoma?

A

They will cause rapid necrosis of the lymphomas, so will create a poor specimen for pathology to evaluate

54
Q

What condition can predispose to CNS lymphoma in immunocompromised patients?

A

EBV infection

55
Q

What is the most common type of brain met in men?

A

Small/ Non-small lung cancer (also prob most common overall)

56
Q

What is the most common brain met in women?

A

Breast cancer

57
Q

What type of cancer has the highest propensity to met to brain (not highest % or incidence, but propensity!)

A

Melanoma

Colon CA and renal cell carcinoma frequently met to brain also

58
Q

What is a finding on MRI that my indicate that you have a brain metastasis?

A

Significant edema out of proportion to the size of the nodules-> Multiple solid and ring enhancing lesions

59
Q

What is treatment of choice with progressive intracranial disease du to brain mets?

A

Whole brain radiation

60
Q

How long is survival for people with metasases of other CA to brain?

A

Anywhere from 1 mo. to a year = shitty

61
Q

An incomplete, or open ring-enhancing lesion on MRI is commonly seen in what kind of condition?

A

Demyelinating condition

62
Q

What are three common signs/ symptoms of a Spinal cord tumor?

A
  1. Pain (most common finding)
  2. Weakness plus UMN/LMN motor findings
  3. Parathesias
63
Q

What are the majority of extradural spinal tumors?

A

Most are metasases to the spinal cord–> breast, lung, prostate, renal call carcinoma

64
Q

What are three common Intradural extramedullary spinal cord tumors?

A
  1. Schwannmas
  2. Neurofibromas
  3. Meningiomas
65
Q

What type of intradural, intramedullary tumor is most common in adults? Peds?

A

Adults –> Ependymoma

Peds–> Astrocytoma

*These are opposite to the brain tumor incidences for these age groups

66
Q

How do meningiomas typically present?

A

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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