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Year Two - Neurology System > Brain Tumours > Flashcards

Brain Tumours Flashcards

1
Q

What are brain tumours?

A

They are defined as a growth of cells within the brain that multiples in an abnormal, uncontrollable manner

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2
Q

What are the six main classifications of brain tumours?

A

Metastatic Brain Cancer

Gliomas

Meningiomas

Vestibular Schwannoma

Medulloblastomas

Craniopharyngioma

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3
Q

What is metastatic brain cancer?

A

It occurs when cancer cells spread from their original site to the brain

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4
Q

What is the most common form of brain tumour?

A

Metastatic brain cancer

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5
Q

What are the five primary tumour sites that most commonly spread to the brain?

A

Lung

Breast

Colorectal

Melanoma

Kidney

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6
Q

What is the most common primary tumour site that spreads to the brain?

A

Lung

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7
Q

What are gliomas?

A

They are defined as tumours that originate from the glial cells of the brain or spinal cord

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8
Q

What are the three subclassifications of gliomas?

A

Astrocytomas

Oligodendrogliomas

Ependymomas

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9
Q

What are astrocytomas?

A

They are defined as tumours that originate from astrocyte cells

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10
Q

What are the function of astrocytes?

A

They maintain the external environment of neurones by maintaining the correct ion concentration

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11
Q

What are the three subclassifications of astrocytomas?

A

Low Grade Astrocytoma

Pilocytic Astrocytoma

Glioblastoma Multiforme

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12
Q

What are low grade astrocytomas?

A

These are defined as benign tumours that develop from slow growing astrocytes

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13
Q

What are pilocytic astrocytomas?

A

These are defined as benign, paediatric tumours that develop from slow growing astrocytes

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14
Q

What investigation can be used to diagnose pilocytic astrocytomas?

A

Brain biopsy

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15
Q

How do pilocytic astrocytomas present on brain biopsies?

A

Rosenthal fibres (corkscrew eosinophilic bundle)

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16
Q

What are the most common primary brain tumours in children?

A

Pilocytic astrocytoma

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17
Q

What are glioblastoma multiformes?

A

These are defined as malignant tumours that develop from rapidly growing, atypical astrocyte

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18
Q

What are the most common primary tumour in adults?

A

Glioblastoma multiformes

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19
Q

What are the two investigations used to confirm the diagnosis of glioblastoma multiforme’s?

A

CT/MRI scans

Brain biopsy

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20
Q

What are the two features of glioblastoma multiforme’s on an MRI scan?

A

An irregular mass with central necrosis and a rim enhanced with contrast

Periventricular subependymal spread

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21
Q

How do glioblastoma multiforme’s present on brain biopsies?

A

They present as pleomorphic tumour cells with bordering necrotic areas

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22
Q

What are oligodendromas?

A

They are defined as tumours that originate from oligodendrocytes cells

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23
Q

What is the function of oligodendromas?

A

They function to form the myelin sheath around the neurone axons

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24
Q

Are oligodendromas benign or malignant?

A

Benign

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25
Q

Where are oligodendromas usually located?

A

Frontal lobes of the brain

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26
Q

What investigation is used to confirm the diagnosis of oligodendromas?

A

Brain biopsy

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27
Q

How do oligodendromas present on brain biopsies?

A

They present as calcifications with a ‘fried-egg’ appearance

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28
Q

What are ependymomas?

A

They are defined as tumours that originate from ependymal cells

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29
Q

What is the function of ependymal cells?

A

They line the ventricles of the brain and central canal of the spinal cord where CSF flows

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30
Q

Are ependymomas benign or malignant?

A

Benign

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31
Q

Where are ependymomas usually located?

A

4th ventricle of the brain

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32
Q

What clinical feature is associated with ependymomas? Why?

A

Hydrocephalus

These tumours can obstruct the flow of CSF

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33
Q

What investigation is used to confirm the diagnosis of ependymomas?

A

Brain biopsy

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34
Q

How do ependymomas present on brain biopsies?

A

Perivascular pseudorosettes

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35
Q

What are meningiomas?

A

They are defined as tumours that originate from meninge cells

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36
Q

What is the function of meninge cells?

A

They form the membranes that surround the brain and spinal cord

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37
Q

What do meningiomas specifically arise from?

A

The arachnoid cap cells of the meninges, which are typically located next to the dura mater

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38
Q

Are meningiomas benign or malignant?

A

Benign

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39
Q

Meningiomas are described as being extra-axial. What does this mean?

A

This means that these tumours are external to the brain parenchyma

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40
Q

What are the four locations in which meningiomas tend to be located?

A

Falx cerebri

Superior sagittal sinus

Convexity

Skull base

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41
Q

What two investigations can be used to confirm the diagnosis of meningiomas?

A

MRI/CT scan

Brain biopsy

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42
Q

How do meningiomas present on MRI/CT scans?

A

They present as well-circumscribed tumours, with a dural tail

43
Q

What is a dura tail?

A

This is a connection between the tumour and dura mater

44
Q

What are the features of meningiomas on brain biopsies?

A

Spindle cells in concentric whorls

Calcified psammoma bodies

45
Q

What is the second most common primary brain tumour in adults?

A

Meningiomas

46
Q

What is another term for vestibular schwannomas?

A

Acoustic neuromas

47
Q

What are vestibular schwannomas?

A

They are defined as tumours that originate from Schwann cells surrounding the eighth cranial (auditory, vestibulocochlear) nerve

48
Q

What is the function of Schwann cells?

A

They wrap around peripheral nerves to provide electrical insulation

49
Q

Are vestibular schwannomas benign or malignant?

A

Benign

50
Q

Where are vestibular schwannomas located? Why?

A

Cerebellopontine angle

This is due to the fact that the eighth cranial nerve is located between the pons and cerebellum

51
Q

What are the four clinical features associated with vestibular schwannomas?

A

Unilateral Hearing Loss

Facial Nerve Palsy

Tinnitus

Imbalance

52
Q

What genetic condition is associated with bilateral vestibular schwannoma?

A

Neurofibromatosis type II

53
Q

What two investigations are used to confirm the diagnosis of vestibular schwannomas?

A

MRI/CT scan

Brain biopsy

54
Q

How do vestibular schwannomas present on an MRI scan?

A

An enhancing mass in the cerebellopontine angle with extension into the internal acoustic meatus

55
Q

What are the two features of vestibular schwannomas on a brain biopsy?

A

Antoni A/B patterns

Verocay bodies

56
Q

What are verocay bodies?

A

They are defined as accelular areas surrounded by nuclear palisades

57
Q

What are medulloblastomas?

A

They are defined as tumours that originate from the embryonic cells in the infratentorial compartment

58
Q

What four structures are contained within the infratentorial compartment?

A

Midbrain

Pons

Medulla

Cerebellum

59
Q

Are medulloblastomas benign or malignant?

A

Malignant

60
Q

Where do medulloblastomas typically metastasise to?

A

CSF system

61
Q

Which patient group tend to be affected by medulloblastomas?

A

Children

62
Q

What investigation is used to confirm the diagnosis of medulloblastomas?

A

Brain biopsy

63
Q

How do medulloblastomas present on brain biopsies?

A

Small, blue cells which appear in a rosette pattern

64
Q

What are craniopharyngiomas?

A

They are defined as tumours that originate from embryonic remnants of Rathke’s pouch in the sellar region

65
Q

What structure arises from Rathke’s pouch?

A

Anterior pituitary gland

66
Q

Are craniopharyngiomas benign or malignant?

A

Benign

67
Q

Which patient group tend to be affected by craniopharyngiomas?

A

Children

68
Q

What are the most common paediatric supratentorial tumours?

A

Craniopharyngiomas

69
Q

What does supratentorial mean?

A

The upper aspect of the brain

70
Q

What clinical feature is associated with craniopharyngiomas?

A

Bitemporal inferior quadrantanopia

71
Q

What are the nine clinical features associated with brain tumours?

A

Nocturnal Headache

Headache Worse Upon Waking

Headache Worse Upon Coughing/Straining

Visual Field Defects

Unilateral Ptosis

Focal Seizures

Hemiparesis

Third & Sixth Cranial Nerve Palsies

Papilloedema

72
Q

What do the clinical features of brain tumours indicate?

A

A raised intracranial pressure

73
Q

What is hemiparesis?

A

It is unilateral weakness of one entire side of the body

74
Q

What does hemiparesis indicate about the location of the brain tumour?

A

The side affected by weakness will be contralateral to the location of the tumour

75
Q

What is papilloedema?

A

It is s swelling of the optic disc secondary to raised intracranial pressure

76
Q

Why is papilloedema a clinical feature of brain tumours?

A

This is due to the fact that the sheath around the optic nerve is connected to the subarachnoid space

77
Q

What investigation can be used to detect papilloedema?

A

Fundoscopy

78
Q

What are the five features of papilloedema on fundoscopy?

A

Blurring of the optic disc margin

Elevated optic disc

Loss of venous pulsation

Engorged retinal veins

Haemorrhage around the optic disc

Paton’s lines

79
Q

What is optic disc elevation?

A

It occurs when the retinal vessels curve over the raised optic disc

80
Q

What are Paton’s lines?

A

They are radiating lines around the optic disc

81
Q

What is third cranial nerve palsy?

A

It is defined as decreased function of the third cranial nerve, resulting in paralysis of the lateral rectus muscles and superior oblique muscles

82
Q

What are the five clinical features of cranial nerve palsy?

A

Ptosis of the superior eyelid

Down + out eyeball position

No pupillary light reflex

Dilated pupil

No accommodation

83
Q

In which eye do the clinical features of third cranial nerve palsy present in?

A

The ipsilateral eye

84
Q

What is sixth cranial nerve palsy?

A

It is defined as reduced function of the sixth cranial nerve, resulting in paralysis of the lateral recuts muscle

85
Q

What is the clinical feature of sixth cranial nerve palsy?

A

Medial deviation of the affected eye

This means that the eye is unable to abduct

86
Q

What three investigations are used to diagnose brain tumours?

A

MRI Scan

PET Scan

Brain Biopsy

87
Q

What is the gold standard investigation used to diagnose brain tumours?

A

MRI scan

88
Q

Which contrast is commonly used in MRI scans of the brain?

A

Gadolinium based contrast

89
Q

How do brain tumours generally present on PET scans?

A

The cancerous growths will uptake more of the radioactive tracer compared to areas of normal tissue

90
Q

What investigation is contraindicated when diagnosing brain tumours? Why?

A

Lumbar puncture

Brain tumours result in a raised intracranial pressure. If a lumbar puncture is conducted in patients who have a raised intracranial pressure, it can lead to herniation syndrome

91
Q

What is herniation syndrome?

A

It occurs when brain tissue, blood and CSF shift from their normal position inside the skull

92
Q

What are the four management options for brain tumours?

A

Surgical Management

Radiotherapy Treatment

Radiosurgery

Chemotherapy Treatment

93
Q

What is the first line management option for brain tumours?

A

Surgical management

94
Q

What are the two surgical procedures used to manage brain tumours?

A

Partial resection

Total resection

95
Q

When are partial resection surgeries used to manage brain tumours?

A

When brain tumours are located near sensitive areas

OR

When they are unable to be completely separated from surrounding tissue

96
Q

When are total resection surgeries used to manage brain tumours?

A

When brain tumours are small and easy to separate from surrounding brain tissue

97
Q

What is radiation therapy?

A

It uses high-powered energy beams to kill cancer cells

98
Q

When is radiation therapy used to manage brain tumours?

A

It is usually combined with chemotherapy to treat cancer in cases where patients are unsuitable for surgery

99
Q

What radiotherapy is used when the brain tumour is proximal to sensitive areas within the brain?

A

Proton radiotherapy

100
Q

What is radiosurgery?

A

It involves the use of multiple beams of radiation to give a highly focused form of radiation treatment to kill the tumour cells in a very small area

The power of each beam is very small, however at the point of the brain tumour where all the beams meet, a large dose of radiation is received to kill the tumour cells

101
Q

What is chemotherapy?

A

It uses drugs to kill cancer cells

102
Q

When is chemotherapy used to manage brain tumours?

A

It is usually prescribed adjuvantly in cases of glioma or metastatic brain tumours

103
Q

What are the three chemotherapy agents used to manage brain tumours?

A

Temozolomide

Cisplastin

Methotrexate

104
Q

What is the main chemotherapy agent used to manage brain tumours?

A

Temozolomide

Year Two - Neurology System (25 decks)

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