Brain Tumours

Question 1

what are common types of primary brain tumours?

Answer 1

neuroepitheal tissue
glioma (glioblastoma multiforme)

meninges
meningioma

pituitary
adenoma

Question 2

what are common tumours that spread to the brain?

Answer 2

renal cell carcinoma
lung carcinoma
breast carcinoma
malignant melanoma
GI tract

Question 3

what is a glioma?

Answer 3

Gliomas can be not cancer (benign) or cancer (malignant). They make up about 3 in 10 of all tumors that start in the brain.

derived from astrocytes

Question 4

how are gliomas graded?

Answer 4

WHO grade I-IV

Question 5

how are grade IV gliomas described?

Answer 5

most common
most aggressive
Glioblastoma multiforme (GBM)
spread by tracking through white mater and CSF pathway
very rarely spread systemically

Question 6

what is a meningioma?

Answer 6

A meningioma is a primary central nervous system (CNS) tumor. This means it begins in the brain or spinal cord. Overall, meningiomas are the most common type of primary brain tumor.

Question 7

what are the characteristics of a meningioma?

Answer 7

slow growing
extra-axial
usually benign
arise from arachnoid
frequently occur along
falx, convexity, or sphenoid bone
usually cured if completely removed

Question 8

what is the most common type of pituitary tumour?

Answer 8

Adenoma most common
Only 1% tumours malignant

Question 9

how does a pituitary tumour present?

Answer 9

visual disturbance
compression of optic chiasm
hormone imbalance

Question 10

how does a brain tumour present clinically?

Answer 10

raised intracranial pressure
(mass effect)

focal neurological deficit

epileptic fits

CSF obstruction

Question 11

what are symptoms of raised ICP?

Answer 11

headache (typically morning headache)
nausea / vomiting
visual disturbance (diplopia, blurred vision)
somnolence
cognitive impairment
altered consciousness

Question 12

what are raised ICP signs?

Answer 12

papilloedema
6th nerve palsy
cognitive impairment
altered consciousness
3rd nerve palsy

Question 13

how much CSF is produced per day?

Answer 13

400 - 450 cc / day

Question 14

which tumours cause hydrocephalous?

Answer 14

tumours in or close to csf pathways

especially posterior fossa tumours

especially in children

Question 15

How is a brain tumour diagnosed?

Answer 15

history and examination
think of sources of secondary tumours (eg CXR)
CT scan
MRI scan
biopsy

Question 16

whay are symptoms of focal neurological defecit?

Answer 16

hemiparesis
dysphasia
hemianopia
cognitive impairment
(memory, sense of direction)
cranial nerve palsy
endocrine disorders

Question 17

A 66 year old, left handed, woman presents with ataxia and
in-coordination.
Where would you suspect
her lesion to be?

Answer 17

cerebellum

Question 18

A 44 year old, right handed, woman presents with acalculia, agraphia,
finger agnosia and right/left confusion.
Where would you suspect
her lesion to be?

Answer 18

Gerstmann’s syndrome occurs with left (dominant) parietal lobe lesions

Question 19

A 30 year old, right handed, man presents with a bi temporal hemianopia.
Where would you suspect
his lesion to be?

Answer 19

Pituitary (macro)adenoma

Question 20

50Y old right handed man Presented to medical team with cognitive language dysfunction:
difficulty reading e mails
difficulty expressing what he wished to say
short-term memory impairment
6 week history of posterior rib pain
PMHx included a left nephrectomy for renal cell carcinoma 5 years previously?

Answer 20

Lesion in left temporo -parietal area

Question 21

which brain tumours cause epilepsy?

Answer 21

only in lesions above tentorium
first fit - 20% chance of tumour
draws attention to possibility of tumour
indicates location of tumour

Question 22

what investigations are done for brain tumours?

Answer 22

Adequate cerebral imaging
CT
MRI
PET
(Angiography)
If suspecting metastasis
CT chest/abdo/pelvis
mammography
biopsy skin lesions/ lymph nodes

Question 23

what are management foals for brain tumour?

Answer 23

accurate tissue diagnosis
– improve quality of life
decreasing mass effect/
improve neurological deficit
– aid effect of adjuvant therapy
(if required)
– prolong life expectancy

Question 24

what are management principles for brain tumours?

Answer 24

corticosteroids (Dexamethasone)
treat epilepsy (anticonvulsant drugs)
analgesics / antiemetics
counselling
surgery
radiotherapy
chemotherapy
endocrine replacement

Question 25

what are manaement options?

Answer 25

Glioblastoma multiforme
complete surgical excision impossible
biopsy or debulk only
medical
Steroids
anticonvulsants
radiotherapy
chemotherapy
temazolamide

Metastasis - most important to confirm diagnosis
11% with abnormal cerebral imaging and a history of cancer, do not have cerebral mets.
medical
steroids, anticonvulsants
radiotherapy
whole brain, steriotatic
surgery

Question 26

what is the prognosis for meningiomas?

Answer 26

commonly cured by surgery
may require anticonvulsants

Question 27

what os the prognois for astrocytomas?

Answer 27

low grade - long life expectancy

high grade / GBM - average 1 yr survival

Question 28

what is the prognosis for metastases?

Answer 28

frequently good medium term remission

Question 29

what do brain tumours present with?

Answer 29

signs of raised intracranial pressure (headache, nausea/vomiting/papilloedema)
seizures
neurological deficit