Brain Tumours

Question 1

Brain tumours vary from benign tumours (e.g. ________-) to highly malignant (e.g. -__________).

Answer 1

vary from benign tumours (e.g. meningiomas) to highly malignant (e.g. glioblastomas).

Question 2

do brain tumours often not have any symptoms?

Answer 2

yes - often no symptoms - particularly when small

Question 3

as brain tumours develop, they present with….

Answer 3

As they develop they present with focal neurological symptoms depending on the location of the lesion.

Question 4

what is the main symptoms a tumour might present with?

Answer 4

Brain tumours often present with symptoms and signs of raised intracranial pressure. As a tumour grows within the skull it takes up space. This leaves less space for the other contents of the skull (such as the CSF) to squeeze in to and leads to a rise in the pressure within the intracranial space.

Question 5

what brain tumour location might cause unusual changes in personality and behaviour?

Answer 5

frontal lobe tumour.

Question 6

best way to detect raised intracranial pressure

Answer 6

Papilloedema is a key finding on fundoscopy in patients with raised intracranial pressure. This is a key component to examination in patients with headaches or other concerning features.

Question 7

give some causes of raised intracranial pressure

Answer 7

Causes

Brain tumours
Intracranial haemorrhage
Idiopathic intracranial hypertension
Abscesses or infection

Question 8

Concerning features of a headache that should prompt further examination and investigation include:

Answer 8

Constant
Nocturnal
Worse on waking
Worse on coughing, straining or bending forward
Vomiting

Question 9

Other presenting features of raised intracranial pressure may be:

Answer 9

Altered mental state
Visual field defects
Seizures (particularly focal)
Unilateral ptosis
Third and sixth nerve palsies
Papilloedema (on fundoscopy)

Question 10

what is papilloedema?

Answer 10

Papilloedema is a swelling of the optic disc secondary to raised intracranial pressure.

Question 11

The sheath around the optic nerve is connected with the ….

Answer 11

The sheath around the optic nerve is connected with the subarachnoid space.

Question 12

give some fundoscopy changes which might be seen in papilloedema

Answer 12

Blurring of the optic disc margin
Elevated optic disc (look for the way the retinal vessels flow across the disc to see the elevation)
Loss of venous pulsation
Engorged retinal veins
Haemorrhages around optic disc
Paton’s lines which are creases in the retina around the optic disc

Question 13

The common cancers that metastasise to the brain are:

Answer 13

Lung
Breast
Renal cell carcinoma
Melanoma

Question 14

what are gliomas

Answer 14

Gliomas are tumours of the glial cells in the brain or spinal cord.

Question 15

what are the 3 main types of glioma?

Answer 15

There are three types to remember (listed from most to least malignant):

Astrocytoma (glioblastoma multiforme is the most common)
Oligodendroglioma
Ependymoma

Question 16

how are gliomas graded?

Answer 16

Gliomas are graded from 1-4. Grade 1 are most benign (possibly curable with surgery). Grade 4 are the most malignant (glioblastomas).

Question 17

what are meningiomas?

Answer 17

Meningiomas are tumours growing from the cells of the meninges in the brain and spinal cord. They are usually benign, however they take up space and this mass effect can lead to raised intracranial pressure and neurological symptoms.

Question 18

memingiomas usually malignant or benign?

Answer 18

usually benign

Question 19

describe pituitary tumours

Answer 19

Pituitary tumours tend to be benign. If they grow large enough they can press on the optic chiasm causing a specific visual field defect called a bitemporal hemianopia. This causes loss of the outer half of the visual fields in both eyes. They have the potential to cause hormone deficiencies (hypopituitarism) or to release excessive hormones leading to:

Acromegaly
Hyperprolactinaemia
Cushing’s disease
Thyrotoxicosis

Question 20

symptoms of pituitary tumours?

Answer 20

bitemporal hemianopia
excessive hormone release -
Acromegaly
Hyperprolactinaemia
Cushing’s disease
Thyrotoxicosis

Question 21

what is Acoustic Neuroma (AKA Vestibular Schwannoma)

Answer 21

Acoustic neuromas are tumours of the Schwann cells surrounding the auditory nerve that innervates the inner ear

Question 22

where do Acoustic Neuroma occur

Answer 22

They occur around the “cerebellopontine angle” and are sometimes referred to as cerebellopontine angle tumours. They are slow-growing but eventually grow large enough to produce symptoms and become dangerous.

Question 23

are Acoustic neuromas usually bilateral or unilateral?

Answer 23

Acoustic neuromas are usually unilateral.

Question 24

what are bilateral acoustic neuromas associated with?

Answer 24

Bilateral acoustic neuromas are associated with neurofibromatosis type 2.

Question 25

Classic symptoms of an acoustic neuroma are:

Answer 25

Hearing loss
Tinnitus
Balance problems

Question 26

acoustic neuromas can also be associated with

Answer 26

facial nerve palsy

Question 27

how do we manage brain tumours?

Answer 27

There is massive variation in brain tumours from completely benign to extremely malignant. Surgery is dependent on the grade and behaviour of the brain tumour.

Management options include:

Palliative care
Chemotherapy
Radiotherapy
Surgery

Question 28

how do we treat pituitary tumours?

Answer 28

Trans-sphenoidal surgery
Radiotherapy
Bromocriptine to block prolactin-secreting tumours
Somatostatin analogues (e.g. ocreotide) to block growth hormone-secreting tumours