Brain metastases (N) Flashcards
What are brain metastases the most common cause of?
Metastatic brain cancer is the most common form of brain tumours in adults
Which cancers most commonly metastasise to the brain? (6)
- lung (most common)
- breast
- colorectal
- testicular
- skin (melanoma)
- kidney
What are the clinical features of brain metastases? (5)
- persistent headaches - worse in mornings and when lying down (suggests raised ICP)
- seizures
- focal neurological deficits (e.g. changes in speech, vision, hearing)
- cognitive deficits
- CN VI palsy (medially diverted eye) and diplopia may be first presentation
What is the first-line investigation for brain metastases?
Imaging (CT/MRI) - can see well-circumscribed tumours at junction of grey and white matter
What imaging do you do for progressively worsening headache with higher cognitive function impaired?
Brain MRI over CT as you can see more detail of brain anatomy
What is the first-line management for brain metastases?
High-dose dexamethasone (reduces cerebral oedema)
How do we manage limited brain metastases?
Surgical resection
What management options do we have for extensive brain metastases? (3)
- stereotactic radiosurgery
- whole brain radiation therapy
- chemotherapy
Describe the prognosis of brain metastases.
Mean survival approximately 1 month without treatment and <1 year with treatment
Describe glioblastoma multiforme. (5)
- glioblastoma is the most common primary tumour in adults associated with poor prognosis (~1y)
- Ix - imaging: solid tumours with central necrosis and a rim that enhances with contrast
- disruption of BBB - associated with vasogenic oedema
- histology: pleomorphic tumour cells border necrotic areas
- Rx: surgical with postoperative chemo and/or radiotherapy; dexamethasone for cerebral oedema
Describe meningioma. (7)
- second most common primary brain tumour in adults (after glioblastoma)
- typically benign, extrinsic tumours of CNS
- arise from arachnoid cap cells of the meninges and are typically located next to the dura and cause Sx by compression rather than invasion
- typically located at falx cerebri, superior sagittal sinus, convexity or skull base
- histology: spindle cells in concentric whorls and calcified psammoma bodies
- Ix: CT (will show contrast enhancement) and MRI
- Rx: observation, radiotherapy or surgical resection
Describe vestibular schwannoma. (6)
- benign tumour arising from CN VIII (vestibulocochlear nerve)
- Sx: hearing loss, facial nerve palsy (compression) and tinnitus
- neurofibromatosis type 2 associated with bilateral vestibular schwannomas
- histology: Antoni A or B patterns seen
- Verocay bodies (acellular areas surrounded by nuclear palisades)
- Rx: observation, radiotherapy or surgery
Describe pilocytic astrocytoma.
- most common primary brain tumour in children
- histology: Rosenthal fibres (corkscrew eosinophilic bundle)
Describe medulloblastoma. (4)
- aggressive paediatric brain tumour that arises within the infratentorial compartment
- spreads through CSF system
- histology: small, blue cells; rosette pattern of cells with many mitotic features
- Rx: surgical resection and chemotherapy
Describe ependymoma. (3)
- commonly seen in 4th ventricle
- may cause hydrocephalus
- histology: perivascular pseudo-rosettes
