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Neurology > Brain Tumours > Flashcards

Brain Tumours Flashcards

1
Q

What are the symptoms of a brain tumour?

A

generalised - apathy, personality change, dementia, drowsiness

  • CN palsy
  • seizures (often initial presentation)
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2
Q

What does focal and generalised symptoms mean?

A

Focal - to do with part of brain injured

Generalised - anything to do with rest of brain

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3
Q

What is the common presentation of a space occupying tumour?

A 
(due to raised ICP)
- headache 
- papilloedema 
- vomiting 
(often also get drowsiness, coma, personality changes or dementia
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4
Q

Why are headaches from raised ICP more common at night?

A
  • ICP increases naturally at night anyway

- so with already high ICP worsened at night

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5
Q

What type of headache will raised ICP cause?

A
  • not great intensity
  • throbbing
  • aggravated by coughing, sneezing, stooping down or exertion
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6
Q

What will be the background of vomiting caused by raised ICP?

A
  • before breakfast
  • accompanied by headache
  • no nausea so no warning
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7
Q

What are the most common primary intracranial tumours?

A

Gliomas (arise from glial cells)
Meningiomas (form meninges)
pituitary adenomas (pituitary cells
schwanommas (cranial nerves)

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8
Q

What are the most common secondary intracranial tumours?

A

spread from:

  • lung
  • breast
  • melanoma
  • renal
  • thyroid
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9
Q

How are gliomas treated?

A

1) biopsy of tissue for diagnosis (either closed or can need open surgery)
2) debulking of tumour surgically
3) radio therapy (sometimes chemo)
4) give temozolomide for glioblastomas

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10
Q

Which tumours are hardest to remove surgically?

A

subcortical or cortical

  • more limited to biopsy
  • surgery not possible
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11
Q

Which gliomas have highest/lowest survival rates?

A

Astrocytomas high grade worst prognosis
Astrocytomas grade I has highest survival
Oligodendrogliomas low grade good prognosis, high grade = bad prognosis

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12
Q

Are most meningiomas benign or malignant?

A

Benign

  • if resectable can become disease free
  • complications of resection if near or connected to nerves/blood vessels
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13
Q

What different treatments can be used for brain metastases?

A

1) surgical resection
2) stereotactic radio surgery
3) whole brain radiotherapy
4) chemotherapy/systemic anti-cancer treatment

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14
Q

What is stereotactic radio surgery?

A
  • low dose radiation is beamed from multiple angles to focus on tumour location (concentrated at location)
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15
Q

What visual disturbances can occur with raised ICP?

A
  • enlargement of blind spot and peripheral construction of fields
  • loss of vision (more commonly intermittent)
  • attacks precipitated by getting up or sleeping
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16
Q

What are the types of gliomas and what cells do they arise from?

A

1) Astrocytoma (astrocytes)
2) Oligogendrogliomas (oligodendrocytes)
3) Ependymomas (ependymal)

17
Q

What is the most common malignant brain tumour?

A

Glial accounts for 80%

18
Q

What is the prognosis of astrocytomas?

A

Prognosis poor even in grade II tumours, likely to progress to malignant, mean survival 5-7 years

19
Q

What are the common complications of surgery for brain tumours?

A
  • can render patient disabled
  • death
  • stroke like symptoms
  • haemorrhage
  • seizures
  • wound infection
20
Q

What surgical techniques are used to reduce complications?

A
  • detailed image guidance (pre-op)
  • Real-time scans
  • Tumour florescence
  • Awake surgery to monitor speech and movement
21
Q

What is the most common presenting symptom of low grade glioma?

A

Seizures

22
Q

What are the type radiation techniques?

A

1) Conventional fractionated
2) Advanced EBRT techniques
3) Stereotactic radiosurgery/therapy

23
Q

What are the most common childhood brain tumours?

A

1) pilocytic astrocytoma
2) medulloblastoma
3) ependypmoma

24
Q

What is the optimal treatment option for childhood brain tumours?

A

1) complete surgical resection is optimal

- radiotherapy is avoided where possible in younger than 4 yr due to toxicity on developing brain

25
Q

What is proton therapy?

A

dose of high energy protons to be precisely targeted at a tumour, reducing the damage to surrounding healthy tissues

26
Q

How do vestibular shwannomas present?

A

Hearing loss
Tinnitus
Balance problems
(benign)

27
Q

How do pituitary macroadenomas present?

A

will compress adjacent structures e.g. optic nerve
resulting in
- vision loss in outer field of both right and left eye

28
Q

How do pituitary microadenomas present?

A
  • prolactinoma
  • GH-secreting (acromegaly)
  • ACTH (Cushing)
29
Q

When is chemotherapy used instead of radiotherapy for brain tumours?

A

malignant gliomas

30
Q

What are the palliative care options for terminal brain tumours?

A
  • medication to manage symptoms
  • dexamethasone for peri-tumoural oedema
  • hospice
  • refer to palliative care team

Neurology (53 decks)

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