Brain Tumor + LMN Flashcards
Who gets brain tumors more, M or W?
They get them both the same
In children under 15… brain cancer
Is the number 1 solid malignancy and number 1 cause of death
What are Lisch nodules?
Growths on the eye in NF-1
Neurofibrosarcomas can develop in:
NF1
Neurofibromatosis genetics:
Variable expression, 100% penetrance
Schwannomas (benign) develop bilaterally in:
NF2
NF2 pathognomonic findings:
Bilateral schwanomas + Cafe au lait spots
Von-hippel-lindau syndrome is autosomal dominant and causes:
Mutation in TS VHL; tumors are hemangioblastomas, pancreatic cysts, kidney tumors and pheochromocytoma
What are the 5 (2S, 3B) cancers you get with p53 mutation (Li Fraumeni):
- Soft tumor
- Sarcoma
- Brain
- Breast
- Blood
What does Turcot’s refer to?
Link between brain and colon cancer
Turcots:
Familial adenomatous polyposis is linked to what type of CA?
Medulloblastoma
FAP:M
Turcots:
HNPCC is linked to what kind of CA?
Glioma
HNPCC: G
WHO criteria: CAME
I: Cell
II: Atypia
III: Mitotic
IV: Endothelial
> 95% of tumors fall into:
GME:
glioma, meningioma, ependyma
Circumscribed WHO I are what type of glioma?
Pilocytic
Ependyomas follow what WHO criteria?
I-III: affect low grade adult spinal cord but high grade in the brains of kids
Most common brain tumor (WHO grade?):
Meningioma (I-II) - Most prevalent after age 35
What CA arises from an arachnoid cap cell?
Meningioma
Most common complaint and then they have CA is:
HA
Increased ICP at what part increases nausea and vomiting?
Postrema of the medulla
If there is aphasia, where is the lesion most likely?
The left frontal or parietal lobe
What is the gold standard for Brain tumor Dx?
MRI with gadolinium
What does SPECT look at?
BBB
What would Diffusion Tensor Imaging be used for?
Imaging water within white matter - currently used in babies
Most common types of brain tumors from mets (3):
- Lung
- Breast
- Colorectal
What two areas are brain mets formed?
- Watershed areas
- At the gray/white matter junction
Treatment with surgery for larger lesions over:
4 cm
Stereotactic radio surgery is for:
Small deer lesions in important areas; no anesthesia
2/3 of patients have seizures after gliomas, treat them with:
High dose dexamethasone (10mg) acutely
Postoperatively brain tumor DVT prophylaxis
LMWH for within 12-24 hours and SCDS + ambulation ASAP
5 Year survival rate:
34.2%
When do you refer to ortho for LMN disorders?
Root, plexus and nerve problems
What are syrinx cavities
Acquired cavitation of the spinal cord that are necrotic
What can you get a syrinx from?
Trauma, myelitis, necrotic spinal cord syndromes and TB (arachnoiditis)
More than 1/2 of the cases of syringomelia are associated with Chiari type 1 which is:
When the cerebellar tonsils poke down and cause increased pressuer
Clinical presentation of Syringomelia is Central cord syndrome which is:
Cape distribution of SENSORY loss and areflexia in the upper limbs (can still feel touch and vibration)
When the cavity in syringomelia gets too big you can get (2):
Urinary defecation issues; spasticity
Amyloid Lateral Sclerosis has degeneration in what two ares of the brain?
Frontal and Temporal
ALS is also called what two things?
Motor neuron disease; Lou Gehrig’s
Age of people that get ALS:
Risk goes up over 40 with highest incidence at 75
Mechanism of ALS: Too much ___
Glutamate (neurotoxicity)
Most common presentation of ALS:
Unilateral arm weakness (Distal > Proximal)
ALS walkers may have:
Slap gait - worsening as the day goes on
Most common cause of death in an ALS patient:
Respiratory failure
Definite diagnosis of ALS is a diagnosis of UMN and LMN in:
3 regions
What test would you order for someone with ALS?
EMG studies, nerve conduction studies
Two medications that are disease-modifying for ALS:
Riluzole: Reduce glutamate excito-toxicity
Edaravone: Reduce oxidative damage
