Brain Metastases

Question 1

What 4 cancers most commonly give rise to brain metastases?

Answer 1

1. Breast
2. Kidney
3. Lung
4. melanoma

Question 2

Give 6 symptoms associated with brain metastases:

Answer 2

1. Headache
2. Nausea and vomiting
3. Increasing memory problems
4. seizures
5. Personality changes
6. weakness or numbness on one side of the body

Question 3

What modality of imaging is employed to investigate brain mets?

Answer 3

MRI head

Question 4

Give 6 presentations associated with raised intracranial pressure:

Answer 4

1. Constant headache
2. Nocturnal
3. Worse on waking
4. Worse on coughing, straining or bending forward
5. Vomiting
6. Papilledema on fundoscopy

Question 5

Give two medications that can be used to relieve symptoms of brain metastases:

Answer 5

1) anti-seizure drugs e.g. phenytoin
2) steroids to reduce swelling

Question 6

What is stereotactic radiosurgery?

Answer 6

where a brain tumour is specifically targeted by multiple beams to kill tumour cells (in contrast to whole-brain radiation therapy)

Question 7

Give 3 methods of brain met treatment:

Answer 7

1) surgery (remove tumour)
2) radiotherapy
3) chemotherapy

Question 8

are the majority of adult brain tumours supra-tentorial or infra-tentorial?

Answer 8

supra-tentorial (upper back of head)

Question 9

are the majority of childhood brain tumours supra-tentorial or infra-tentorial?

Answer 9

infra-tentorial

Question 10

what are clinical features of brain metastasis?

Answer 10

• cranial nerve palsies (specifically abducens nerve)
• Cushing’s reflex
• drowsiness, seizures, pupillary abnormalities, papilloedema, weight loss, malaise, pain, changes in memory and neurological deficit

Question 11

What is cushing’s reflex?

Answer 11

Cushing’s triad refers to a set of signs that are indicative of increased intracranial pressure (ICP), or increased pressure in the brain. Cushing’s triad consists of bradycardia (also known as a low heart rate), irregular respirations, and a widened pulse pressure. A widened pulse pressure occurs when there is a large difference between the systolic blood pressure (the blood pressure when the heart is contracting) and the diastolic blood pressure (the blood pressure when the heart is relaxing).

Question 12

which cranial nerve is most commonly affected by space occupying lesions?

Answer 12

abducens nerve (CN VI)

• weakness in lateral rectus muscle > inability to abduct the affected side > eye turns inwards due to unopposed medial rectus muscle

Question 13

what are the investigations for suspected space occupying lesions?

Answer 13

CRANIAL IMAGING

• CT head = acute
• MRI = lesions
• CT CAP = primary lesion
• PET scan as last resort