Brain Tumors Flashcards
Epidemiology of brain tumors in children:
Most common solid tumor in kids.
Second only to Leukemia in malignancies.
Most common are: Low-grade astrocytomas and Medulloblastomas.
Most common adult brain tumors: ___ and ___.
Male/female predominance?
Highest incidence age?
Glioblastomas and Gliomas (50%):
Malignant astrocytomas
Meningiomas.
Male predominance for most tumors, except Meningiomas which have famale predominance.
Highest incidence 75-84 yrs.
Known environmental risk factors for brain tumors?
Irradiation and acquired immunosuppression - HIV, chronic immunosuppressive therapy.
Neurofibromatosis Type 1 increases risk of what CNS tumor(s)?
Gliomas
Neurofibromatosis Type 2 increases risk of what CNS tumor(s)?
Vestibular schwannomas
Meningiomas
Li-Fraumeni increases risk of what CNS tumor(s)?
Gliomas
Medulloblastomas
Tuberous sclerosis increases risk of what CNS tumor(s)?
Subependymal giant cell astrocytomas,
Cortical hamartomas.
Hippel-Lindau Syndrome increases risk of what CNS tumor(s)?
Hemangioblastomas in brain, cord, and retina.
Also RCC.
Burkitt Syndrome and HNPCC increases risk of what CNS tumor(s)?
Glioblastoma.
Medulloblastoma.
Glioblastomas and Gliomas WHO Grade I:
Pilocytic Astrocytoma:
primarily in kids, excellent prognosis.
Glioblastomas and Gliomas WHO Grade II:
Astrocytoma.
Oligodendroglioma.
Epedymoma.
-benign but can progress to grade III or IV.
Glioblastomas and Gliomas WHO Grade III:
Anaplastic Astrocytoma.
Anaplastic Oligodendroglioma.
Anaplastic Epedymoma.
- bad prognosis
Glioblastomas and Gliomas WHO Grade IV:
Glioblastoma multiforme (GBM). -worst prognosis, highly infiltrative, malignant although rarely mets outside CNS.
Meningiomas:
30% of all primary CNS tumors. 90% are intracranial.
Rare in children.
Originate from Arachnoid.
Associated with NF2
Vestibular Schwannomas:
Benign tumors that arise from CNVIII.
90% Vestibular branch.
If bilateral –> NF2.
Can affect other CNs, cerebellum, pons.
Pituitary Tumors:
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.
Metastatic tumors:
8x more likely than primary.
Most common is Nonsmall cell lung cancer.
Also: Melanoma, Small cell lung cancer, breast, renal, GI.
Spinal cord tumors:
- Intramedullary - 10%. More in kids.
- Extramedullary: intradural and extradural.
- Mets: Lung, breast, prostate.
Most common symptom of CNS tumor? Other symptoms?
Headache - 30-40%.
Personality/behavior change.
Focal symptoms: vertigo, aphasia, hemiparesis, anosmia, bitemporal hemianopia, visual loss, facial weakness, diplopia, seizures….
Occipital lobe tumor symptoms?
Hemianopia and unformed visual disturbances.
Frontal lobe tumor symptoms?
Seizures, dementia, behavioral changes, gait changes, hemiparesis.
Temporal lobe tumor symptoms?
Behavioral +- language change, olfactory, partial complex seizure, visual field defects
Corpus callosum tumor symptoms?
Anterior –> dementia.
Splenium involvement –> behavior, memory loss.
Cerebellar/Pontine tumor symptoms?
Ipsilateral deafness, facial numbness/weakness, ataxia, HA, nystagmus, neck pain.
Pituitary tumor symptoms?
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.
spinal cord tumor symptoms?
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.
Imaging of choice for tumor?
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.
When to do an LP?
To stage primary CNS lymphoma, intracranial germ cell tumor, pineoblastoma. Do Not do if increased ICP.
Management of CNS tumors?
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.
