Brain metastases Flashcards
What are brain metastases?
Brain metastases are among the most common intracranial tumours in adults and signify an advanced disease state with a significant impact on morbidity and mortality.
What are the primary cancers most likely to metastasize to the brain?
The primary cancers are lung, breast, melanoma, renal, and colorectal cancers.
How prevalent are brain metastases compared to primary brain tumours?
Brain metastases are more prevalent, accounting for approximately 30-40% of all intracranial neoplasms.
What percentage of brain metastases are due to lung cancer?
Lung cancer accounts for 40-50% of brain metastases.
What percentage of brain metastases are due to breast cancer?
Breast cancer accounts for 15-25% of brain metastases.
What are the pathways of spread for brain metastases?
The pathways include hematogenous spread (most common), lymphatic spread, and direct extension (rare).
What are common clinical features of brain metastases?
Common features include headaches, neurological deficits, seizures, cognitive and behavioural changes, and symptoms of increased intracranial pressure.
What is the gold standard for diagnosing brain metastases?
MRI with contrast is the gold standard for diagnosis.
What is the aim of managing brain metastases?
The aim is to control symptoms, reduce tumour burden, and improve quality of life.
What supportive care is used for brain metastases?
Supportive care includes corticosteroids, anticonvulsants, and palliative care consultations.
What is Whole Brain Radiotherapy (WBRT)?
WBRT is used for multiple metastases but is associated with notable cognitive decline.
What is Stereotactic Radiosurgery (SRS)?
SRS is preferred for patients with 1-3 metastases, offering high-dose radiation with minimal damage to surrounding tissues.
What systemic therapies are used for brain metastases?
Systemic therapies include chemotherapy, targeted therapy, or immunotherapy depending on the primary tumour type.
When is surgical resection indicated for brain metastases?
Surgical resection is indicated for accessible lesions causing significant mass effect or when histologic diagnosis is required.
What is the prognosis for patients with brain metastases?
Survival rates are generally poor but improving with advances in targeted therapies and precision medicine.
What is the median survival for patients with brain metastases?
Median survival ranges from several months to over a year, depending on treatment strategies and tumour biology.
What are the causes of brain abscesses?
Brain abscesses may result from extension of sepsis from middle ear or sinuses, trauma or surgery to the scalp, penetrating head injuries, and embolic events from endocarditis.
What symptoms are associated with brain abscesses?
Symptoms depend on the site of the abscess and may include headache, fever, focal neurology, and features consistent with raised intracranial pressure.
What is the nature of headaches associated with brain abscesses?
Headaches are often dull and persistent.
Is fever always present in brain abscess cases?
Fever may be absent and is usually not the swinging pyrexia seen with abscesses at other sites.
What focal neurological signs may occur with brain abscesses?
Focal neurology may include oculomotor nerve palsy or abducens nerve palsy secondary to raised intracranial pressure.
What are other features consistent with raised intracranial pressure?
Other features include nausea, papilloedema, and seizures.
What imaging is used to assess brain abscesses?
Assessment includes imaging with CT scanning.
What is the surgical management for brain abscesses?
A craniotomy is performed, and the abscess cavity is debrided.
What is a potential complication after abscess drainage?
The abscess may reform because the head is closed following abscess drainage.
What antibiotics are used in the management of brain abscesses?
IV antibiotics include a 3rd-generation cephalosporin plus metronidazole.
How is intracranial pressure managed in brain abscess cases?
Intracranial pressure management may include dexamethasone.
