Brain Tumors

Question 1

Epidemiology of brain tumors in children:

Answer 1

Most common solid tumor in kids.
Second only to Leukemia in malignancies.
Most common are: Low-grade astrocytomas and Medulloblastomas.

Question 2

Most common adult brain tumors: ___ and ___.
Male/female predominance?
Highest incidence age?

Answer 2

Glioblastomas and Gliomas (50%):
Malignant astrocytomas
Meningiomas.

Male predominance for most tumors, except Meningiomas which have famale predominance.

Highest incidence 75-84 yrs.

Question 3

Known environmental risk factors for brain tumors?

Answer 3

Irradiation and acquired immunosuppression - HIV, chronic immunosuppressive therapy.

Question 4

Neurofibromatosis Type 1 increases risk of what CNS tumor(s)?

Answer 4

Gliomas

Question 5

Neurofibromatosis Type 2 increases risk of what CNS tumor(s)?

Answer 5

Vestibular schwannomas

Meningiomas

Question 6

Li-Fraumeni increases risk of what CNS tumor(s)?

Answer 6

Gliomas

Medulloblastomas

Question 7

Tuberous sclerosis increases risk of what CNS tumor(s)?

Answer 7

Subependymal giant cell astrocytomas,

Cortical hamartomas.

Question 8

Hippel-Lindau Syndrome increases risk of what CNS tumor(s)?

Answer 8

Hemangioblastomas in brain, cord, and retina.

Also RCC.

Question 9

Burkitt Syndrome and HNPCC increases risk of what CNS tumor(s)?

Answer 9

Glioblastoma.

Medulloblastoma.

Question 10

Glioblastomas and Gliomas WHO Grade I:

Answer 10

Pilocytic Astrocytoma:

primarily in kids, excellent prognosis.

Question 11

Glioblastomas and Gliomas WHO Grade II:

Answer 11

Astrocytoma.
Oligodendroglioma.
Epedymoma.
-benign but can progress to grade III or IV.

Question 12

Glioblastomas and Gliomas WHO Grade III:

Answer 12

Anaplastic Astrocytoma.
Anaplastic Oligodendroglioma.
Anaplastic Epedymoma.
- bad prognosis

Question 13

Glioblastomas and Gliomas WHO Grade IV:

Answer 13

Glioblastoma multiforme (GBM).
-worst prognosis, highly infiltrative, malignant although rarely mets outside CNS.

Question 14

Meningiomas:

Answer 14

30% of all primary CNS tumors. 90% are intracranial.
Rare in children.
Originate from Arachnoid.
Associated with NF2

Question 15

Vestibular Schwannomas:

Answer 15

Benign tumors that arise from CNVIII.
90% Vestibular branch.
If bilateral –> NF2.
Can affect other CNs, cerebellum, pons.

Question 16

Pituitary Tumors:

Answer 16

Peaks in 3-4th decade.
Almost always benign.
Secreting much less common.
Presentation:
1. bitemporal hemianopia (2/2 compression of optic chiasm.
2. Pituitary apoplexy 2/2: sudden hemorrahage or infarction of tumor: sudden HA, occulomotor palsies with diplopia, nausea/vomit, altered mental status, vision loss.

Question 17

Metastatic tumors:

Answer 17

8x more likely than primary.
Most common is Nonsmall cell lung cancer.
Also: Melanoma, Small cell lung cancer, breast, renal, GI.

Question 18

Spinal cord tumors:

Answer 18

1. Intramedullary - 10%. More in kids.
2. Extramedullary: intradural and extradural.
3. Mets: Lung, breast, prostate.

Question 19

Most common symptom of CNS tumor? Other symptoms?

Answer 19

Headache - 30-40%.
Personality/behavior change.
Focal symptoms: vertigo, aphasia, hemiparesis, anosmia, bitemporal hemianopia, visual loss, facial weakness, diplopia, seizures….

Question 20

Occipital lobe tumor symptoms?

Answer 20

Hemianopia and unformed visual disturbances.

Question 21

Frontal lobe tumor symptoms?

Answer 21

Seizures, dementia, behavioral changes, gait changes, hemiparesis.

Question 22

Temporal lobe tumor symptoms?

Answer 22

Behavioral +- language change, olfactory, partial complex seizure, visual field defects

Question 23

Corpus callosum tumor symptoms?

Answer 23

Anterior –> dementia.

Splenium involvement –> behavior, memory loss.

Question 24

Cerebellar/Pontine tumor symptoms?

Answer 24

Ipsilateral deafness, facial numbness/weakness, ataxia, HA, nystagmus, neck pain.

Question 25

Pituitary tumor symptoms?

Answer 25

Gonadotroph failure - sex dysfun, amenorrhea, infertility.
Thyroid Dysfunction - fatigue, malaise, weight gain, apathy, constipation.
Somatotroph fialure - weight gain, reduced bone mass, hyperchlesterolemia, muscle weakness.
Corticotroph failure - fatigue, weight loss, decreased appetite, hypoglycemia.

Question 26

spinal cord tumor symptoms?

Answer 26

Extramedullary: compression of cord or occlusion of vessels - progressive weakness below level of tumor, sensory changes, brisk reflexes, upgoing toes to plantar stimulation, urinary retention, constipation.
Intramedullary: interference of intrinsic cord structures - mass effect and edema, syrinx formation.

Question 27

Imaging of choice for tumor?

Answer 27

MRI with and without contrast is the choice.
-Lack of enhancement: low grade tumor.
- can see BBB disruption, hemorhage in tumor.
CT may miss smaller tumors in posterior fosa, will also show hemorrhage.

Question 28

When to do an LP?

Answer 28

To stage primary CNS lymphoma, intracranial germ cell tumor, pineoblastoma. Do Not do if increased ICP.

Question 29

Management of CNS tumors?

Answer 29

Surgery for easily resected: meningioma, pituitary adenoma.
Radiation for malignant.
Gamma knife for slower growing tumors - schwannomas, meningiomas.
Steroids- reduces edema if increased ICP, indicated in all symptomatic patients; cant use long term due to Pneumocystis carinii infection risk. Abx if use >6wks.
Anticonvulsants - nonhepatic ones: Valproic acid, lamotrigine, topiramate, gabapentin, levetiracetam.
Monitor for thromboembolism–> anticoagulant.