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Neuro > Brain Tumours > Flashcards

Brain Tumours Flashcards

1
Q

What are primary and secondary types of brain tumour?

A

Primary - neuroepithelial tissue, glioma, meningioma and adenoma of pituitary
Secondary - commonest tumours which spread to brain - renal cell, lung, breast, malignant melanoma and GIT

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2
Q

What is the most common brain tumour?

A

Metastases
15-30% of cancer patients get cerebral metastases
Increasing incidence

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3
Q

Describe gliomas

A

Are derived from astrocytes - structural and nutritional support to nerve cells
Grade IV is most common and aggressive
Glioblastoma multiforme GBM
Spread by tracking though white matter and CSF

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4
Q

What are some characteristics of meningiomas?

A

Slow growing, extra-axial, usually benign, arises from arachnoid, usually cured if completely removed and mainly occur along falx, convexity or sphenoid

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5
Q

Describe pituitary tumours

A

Adenoma most common
Only 1% tumour malignant
Presents with visual disturbance and hormone imbalance

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6
Q

What is the clinical presentation of brain tumours?

A

Raised intracranial pressure
Focal neurological deficit
Epileptic fits
CSF obstruction

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7
Q

What are some raised ICP symptoms?

A

Headache - typically morning
Nausea and vomiting
Visual disturbance - diplopia and blurred vision
Somnolence
Cognitive impairment
Altered consciousness

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8
Q

What are some raised ICP signs?

A

Papilledema
6th nerve palsy
Cognitive impairment
Altered consciousness
3rd nerve palsy - diplopia

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9
Q

What tumours cause hydrocephalus?

A

Tumours in or close to CSF pathways
Esp. posterior fossa tumours
Especially children

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10
Q

How are brain tumour diagnosed?

A

History and exam
CXR sources of secondary tumour
CT and MRI scans
Biopsy

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11
Q

What are symptoms of focal neurological deficit?

A

Hemiparesis, dysphasia, hemianopia, cognitive impairment, cranial nerve palsy and endocrine disorders

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12
Q

Where would lesion suspected to be if left landed women presents with ataxia and in-coordination?

A

Cerebellum

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13
Q

Where would lesion suspected to be if women is right handed and presents with acalculia, agraphia, finger agnosia and right/left confusion?

A

Left parietal lobe

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14
Q

What occurs with left (dominant) parietal lobe lesions?

A

Gerstmann’s syndrome

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15
Q

Where would lesion be suspected if right handed man has bi temporal hemianopia?

A

Pituitary

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16
Q

Where would the lesion be suspected if right handed man has cognitive language dysfunction?

A

Left temporo-parietal area

17
Q

Describe epilepsy and brain tumours

A

Focal or generalised epilepsy
Only in lesions above tentorium
Affects cerebrum - mainly frontal and temporal
Can indicate the location of tumour

18
Q

What investigations are done?

A

CT, MRI and PET
Angiography possibly
If suspect metastases - CT chest/abdo/pelvis, mammography and biopsy skin lesions and lymph nodes

19
Q

What is the management goals for brain tumours?

A

Accurate tissue diagnosis
Improve QoL
Aid effect of adjuvant therapy
Prolong life expectancy

20
Q

What are the management principles for brain tumours?

A

Corticosteroids - dexamethasone
Treat epilepsy - anticonvulsant drugs
Analgesics/ antiemetics
Surgery, RT, Chemo and endocrine replacement

21
Q

What are the management options for glioblastoma multiforme?

A

Complete surgical excision impossible - biopsy or debulk only
Medical - steroids and anticonvulsants
RT and Chemo - temozolomide

22
Q

What is the management options of metastasis?

A

Confirm diagnosis
Medical - steroids and anticonvulsants
RT - whole brain or stereotactic
Surgery

23
Q

What is the prognosis of meningioma?

A

Commonly cured by surgery
May require anticonvulsants

24
Q

What is the prognosis of GMB?

A

Low grade then long life expectancy
High grade then average 1 year

25
Q

What is the prognosis of metastases?

A

Frequently good medium term remission

26
Q

What is the treatment of meningioma?

A

Surgical excision

27
Q

When should lumbar puncture not be performed?

A

When there is signs and symptoms to suggest an intracranial mass lesion

28
Q

Why not do a LP if intracranial lesion?

A

Might cause herniation syndrome and patient could die

29
Q

What are primary benign brain tumours?

A

Meningioma and pituitary adenoma

Neuro (40 decks)

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