Brain Tumours Flashcards
What is meant by a primary brain tumour?
Tumour which arises in brain itself
->usually one tumour
What is meant by a secondary brain tumour?
Tumour which has spread to the brain
->usually more than one tumour
If a tumour arises from neuroepithelia tissue, what is it known as?
Glioma
If a tumour arises from the meninges, what is it known as?
Meningioma
If a tumour arises from the pituitary gland, what is it known as?
Adenoma
Give some examples of common tumours which can spread to the brain.
Renal cell carcinoma
Lung carcinoma
Breast carcinoma
Malignant melanoma
GIT
Which cells are gliomas derived from?
Astrocytes
List some of the characteristics of meningiomas.
Slow growing
Usually benign
Extra-axial
Where do meningiomas arise from?
Arachnoid
How can pituitary tumours present?
Visual disturbances as compress the optic chiasm
Hormone imbalance
What is the general clinical presentation for a brain tumour?
Raised intracranial pressure
Focal neurological deficit
Epileptic fits
CSF obstruction
What are some of the symptoms suggesting raised intracranial pressure?
Headache- typically morning headache
Nausea/vomiting
Visual disturbances e.g. diplopia, blurred vision
Somnolence- state or drowsiness or strong desire to fall asleep
Cognitive impairment
Altered consciousness
What are some signs of raised intracranial pressure?
Papilloedema
6th nerve palsy
Cognitive impairment
Altered consciousness
3rd nerve palsy
What needs to be done to reach a diagnosis of brain tumour?
History and examination
Think of secondary sources- e.g. CXR
CT
MRI
Biopsy
List some focal neurological deficits.
Hemiparesis
Dysphasia
Hemianopia
Cognitive impairment
Cranial nerve palsy
Endocrine disorders
A 66yr old, left handed women presents with ataxia and in-coordination. Where would you suspect there to be a lesion?
Cerebellum
A 44yr old, right handed women presents with acalculia (inability to perform calculations and process numbers), agraphia (inability to write) and right/left confusion.
Where would you suspect her lesion to be?
Left parietal lobe
-> as right handed, left hemisphere is dominant
Which syndrome occurs with left parietal lobe lesions?
Gerstmann’s syndrome
A 30 yo, right handed man presents with a bitemporal hemianopia. Where would you suspect his lesion to be?
Pituitary gland
-> compresses on optic region
50 yo, right handed man presents with cognitive language dysfunction as has difficulty reading emails and struggles to express what he wants to say.
He has a short term memory impairment and a 6wk history of posterior rib pain.
PMH: left nephrectomy for renal cell carcinoma 5yrs ago.
Where do you think the lesion is?
Left temporal parietal
->rib pain was due to bone metastasis btw
Which areas of the brain are very epileptogenic?
Frontal and temporal
What are the management goals for someone with a brain tumour?
Accurate tissue diagnosis
Improve QoL
Aid effect of adjuvant therapy if required
Prolong life expectancy
List some of the management options for brain tumours.
Corticosteroids e.g. dexamethasone to reduce oedema
Treat epilepsy
Analgesics
Surgery
Radiotherapy
Chemotherapy
Endocrine replacement
Benign meningioma is curative, what can be done?
Surgical excision
DO NOT DO A LUMBAR PUNCTURE WHEN THERE ARE SIGNS AND SYMPTOMS SUGGESTIVE OF A INTRACRANIAL MASS LESION.
Why?
-May cause meningitis
-May cause herniation syndrome and patient could die
-May cause air embolism
-May make headache worse
