Brain tumours

Question 1

Name some brain tumours

Answer 1

astrocytoma
oligoastrocytoma
oligodendroglioma
ganglioglioma
ependymoma
meningioma

Question 2

What are some features of malignant brain tumours (pathologically)

Answer 2

anaplasia - progressive loss of structural differentiation
mitotic activity
necrosis
endothelial/microvascular proliferation

Question 3

What are the most common solid tumours in children <15?

Answer 3

brain tumours

Question 4

How can brain tumours metastasise?

Answer 4

via CSF (drop metastasis)

Question 5

What separates the supratentorium and infratentorium?

Answer 5

tentorium cerebelli - thick dura

Question 6

What components are in the supratentorial compartment?

Answer 6

diencephalon
cerebral hemispheres
basal ganglia
parts of midbrain

Question 7

What components are in the infratentorial compartment?

Answer 7

cerebellum
brainstem

Question 8

What are the most common brain tumours in children?

Answer 8

gliomas
medulloblastomas

Question 9

How can brain tumours present in children?

Answer 9

persistent/recurrent vomiting
persistent headache
abnormal balance/walking/coordination
blurred or double vision
abnormal eye movement
behaviour change (lethargy)
fits or seizures (without fever)
abnormal head positioning (head tilt or stiff neck)
specific (cranio or optic glioma)

Question 10

What type of brain tumour has the potential to cause obstructive hydrocephalus?

Answer 10

infratentorial tumour
can block CSF outflow

Question 11

How should a child with a suspected brain tumour be examined?

Answer 11

general paediatric examination
neurological examination (GCS, cranial nerves, ophthalmoscopy, peripheral nerve examination)
CT (?hydrocephalus)
ophthalmology
MRI head and spine with contrast
endocrinology

Question 12

How is a paediatric brain tumour treated?

Answer 12

?need for CSF diversion
steroids with PPI cover
surgery
adjuvant therapy

Question 13

Symptoms of brain tumours in adults

Answer 13

headaches
memory/cognition/personality change
seizures
weakness
balance issues
visual disturbance
hearing issues/tinnitus

Question 14

How should an adult with a suspected brain tumour be assessed?

Answer 14

CT head
MRI head with contrast
staging CT
visual fields/ophthalmology
hearing test/audiometry
assess need for steroids with PPI cover
assess need for CSF diversion

Question 15

Describe memingiomas

Answer 15

benign, slow-growing lesions
derived from arachnoid cap cells

Question 16

How can pituitary tumours affect vision?

Answer 16

can press on optic chiasm
cause visual field defects (bitemporal hemianopia)
can cause decreased visual acuity

Question 17

What is the most common site of secondary brain tumours?

Answer 17

frontal lobe (but can be anywhere, including durally based)

Question 18

What are the most common primary malignancies to metastasise to the brain?

Answer 18

lung
breast
melanoma
colon
kidney

Question 19

How does an abscess show on a scan?

Answer 19

ring enhancing brain lesion