Brain Tumours Flashcards
Brain tumours vary from benign tumours (e.g. ________-) to highly malignant (e.g. -__________).
vary from benign tumours (e.g. meningiomas) to highly malignant (e.g. glioblastomas).
do brain tumours often not have any symptoms?
yes - often no symptoms - particularly when small
as brain tumours develop, they present with….
As they develop they present with focal neurological symptoms depending on the location of the lesion.
what is the main symptoms a tumour might present with?
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.
what brain tumour location might cause unusual changes in personality and behaviour?
frontal lobe tumour.
best way to detect raised intracranial pressure
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.
give some causes of raised intracranial pressure
Causes
Brain tumours
Intracranial haemorrhage
Idiopathic intracranial hypertension
Abscesses or infection
Concerning features of a headache that should prompt further examination and investigation include:
Constant
Nocturnal
Worse on waking
Worse on coughing, straining or bending forward
Vomiting
Other presenting features of raised intracranial pressure may be:
Altered mental state
Visual field defects
Seizures (particularly focal)
Unilateral ptosis
Third and sixth nerve palsies
Papilloedema (on fundoscopy)
what is papilloedema?
Papilloedema is a swelling of the optic disc secondary to raised intracranial pressure.
The sheath around the optic nerve is connected with the ….
The sheath around the optic nerve is connected with the subarachnoid space.
give some fundoscopy changes which might be seen in papilloedema
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
The common cancers that metastasise to the brain are:
Lung
Breast
Renal cell carcinoma
Melanoma
what are gliomas
Gliomas are tumours of the glial cells in the brain or spinal cord.
what are the 3 main types of glioma?
There are three types to remember (listed from most to least malignant):
Astrocytoma (glioblastoma multiforme is the most common)
Oligodendroglioma
Ependymoma
how are gliomas graded?
Gliomas are graded from 1-4. Grade 1 are most benign (possibly curable with surgery). Grade 4 are the most malignant (glioblastomas).
what are meningiomas?
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.
memingiomas usually malignant or benign?
usually benign
describe pituitary tumours
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
symptoms of pituitary tumours?
bitemporal hemianopia
excessive hormone release -
Acromegaly
Hyperprolactinaemia
Cushing’s disease
Thyrotoxicosis
what is Acoustic Neuroma (AKA Vestibular Schwannoma)
Acoustic neuromas are tumours of the Schwann cells surrounding the auditory nerve that innervates the inner ear
where do Acoustic Neuroma occur
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.
are Acoustic neuromas usually bilateral or unilateral?
Acoustic neuromas are usually unilateral.
what are bilateral acoustic neuromas associated with?
Bilateral acoustic neuromas are associated with neurofibromatosis type 2.
Classic symptoms of an acoustic neuroma are:
Hearing loss
Tinnitus
Balance problems
acoustic neuromas can also be associated with
facial nerve palsy
how do we manage brain tumours?
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
how do we treat pituitary tumours?
Trans-sphenoidal surgery
Radiotherapy
Bromocriptine to block prolactin-secreting tumours
Somatostatin analogues (e.g. ocreotide) to block growth hormone-secreting tumours
