Brain Tumor and multi-disciplinary management Flashcards
Brain Tumor
- often poor prognosis
- benign brain tumors are often difficult to remove because they can be close to a part of the brain with important functions ex. acoustic neuromas that lye beside the brainstem
and there can be no clear boundary between tumour tissue and normal brain tissue
resectioin is the removal of part of an organ- doing this can result in a permanent brain injury
Primary
Primary:
- Gliomas- collective term that originate in the brain or spinal cord CNS
ex. Astrocytomas are the most common primary brain tumor in adults and children- grows bigger but does not spread
Secondary Tumors
Metastatic
- spread in the CNS from systemic cancer sites outside the brain
- start outside the CNS
Common Brain tumors
- Gliomas
- can be both benign and malignant
- astrocytomas are most common glial tumor
Grade 1= benign
ex.
1. Meningioma- arise from the meninges
2. Pituitary adenomas: affect the optic tract, edocrine disturbance
3. Acoustic Neuroma- large size cause brainstem displacement and raised intracranial pressure
Grade 4: highly malignant
ex. metastatic carcinoma- 60% of all brain tumors
Astrocytomas and metastic carcinomas comprise of 60% of all brain timors
Symptoms
- Raised intracranial pressure
- epilepsy
- neurological deficits
Meningiomas
- another common brain timor
- always benign
- from any part of the meninges
- Possible for total removal as long as it is not attached to dural venous sinuses
Pituitary adenomas
- Space- occupying effects- the space that is occupied lead to effects
- compressing the optic nerves/chiasm/tracts
- commonly presented with monocular blindness due to optic nerve compression or hemianopia from optic tract compression- loss of half of the visual field
See picture!
Symptoms of pituitary adenomas
- Double vision
- simultaneous perception of 2 images of a single object
result of impaired function of the extraocular muscles, both eyes are still functioning, but cannot converge to target
the desired object - muscles controlling the object don’t work as well
Endocrine disturbances
- if tumor cells are secretory there is a positive disturbance
- if preventing normal secretions- negative disturbance
Pituitary adenomas and cranial nerves
lateral expansion can compress the cranial nerves 3, 4 and 6 and also cause numbness of the forehead
If there is a tumor on the chiasm= tunnel vision
3rd cranial nerve
- Looking up in the abducted position
- Looking down in the abducted position
- Adducting medial
- Looking up in the adducted position
4th cranial nerve
- looking down in the adducted position
6th cranial nerve
- abducting laterally
Summary
benign
- grade 1-2 glioma
- meningioma
- pituitary adenoma
- Acoustic neuroma
Malignant
- Primary- grade 3-4 glioma
- secondary- metastatic carcinoma
One hemisphere too large
supratentorial midline structures
- ex. corpus callosum and 3rd ventricle are pushed towards the opposite side of the skills
- the inferior medial part of the cerebral hemisphere is pushed which compresses the mid brain
- brainstem pushed down
impacts
this can cause a decrease in consciousness, decrease in pupil’s reaction to light (3rd cranial nerve palsy)
decrease in vital functioning including breathing
- coning caused by downward movement of brainstem
Mass lesion situated in the midline
- cause obstruction of CSF
- pushing both the cerebral hemispheres
- pushing down midbrain
- similar effects as above
Unilateral posterior fossa mass lesion
- compress the 4th ventricle, block downward flow of CSF
cerebellum function implicated- movement, coordination and balance
Coning may occur depending on the size of the mass
What are the key characteristics of cerebellar dysfunction
- Intention Tremor
- occurs during voluntary movement
- absent at rest
-intensifies at the termination of movement
-MS
Tests- problems with precision and can do the finger to finger test and the finger to nose test - Adiadochokinesis- related to coordination
- unable to perform rapid alternating movements ex. pronation and supination, and elbow flexion and extension
Test: within several seconds count how many alternations a patient can make- compare affected with unaffected limb
- Dysdiadochokinesia
- decrease ability to perform rapid alternating movements smoothly - Ataxia
- delayed initiation of movement responses
- results in jerky, poorly controlled movement, poor postural stability- poor agonist and antagonist coordination
Test: observe patient reaching- look for ataxic gait
- Nystagmus
- involuntary oscillating movement of eyes
- also appears in brainstem and vestibular lesions
- Tests: observe patient when he/she is looking at a fixed object- dysarthria- speech problem - Romberg sign
- inability to maintain standing balance with feet together and eyes closed- push slightly to see whether patients are able to compensate and regain posture- a positive romberg sign is excessive swaying or even falling over - Proprioceptive dysfunction: damage anywhere along the pathway from the proprioceptive sensors to the cerebellum can give rise to cerebellar ataxia
Specific Symptoms of Brain tumors
- headaches
- nausea and vomiting
- changes in speech, vision, or hearing
- problems with balance or walking
- changes in mood or ability to concentrate
- problems with memory
- Muscle jerking or twitching
- Numbness or tingling in the arms or legs
Clinical features and implications on functions
- Intracranial pressure
- head ache, vomiting, depression of conscious level, coning, false localizing signs ( 6th cranial nerve palsy, frontal signs and behavioural changes)
Clinical features- Frontal
tend to present late since tumors can become large before producing a definite neurological deficit
- dementia
- alteration of mood and behaviour
- incomplete insight
- olfactory or optic nerve malfunction
