Brain Tumours

Question 1

What is meant by a primary brain tumour?

Answer 1

Tumour which arises in brain itself

->usually one tumour

Question 2

What is meant by a secondary brain tumour?

Answer 2

Tumour which has spread to the brain

->usually more than one tumour

Question 3

If a tumour arises from neuroepithelia tissue, what is it known as?

Answer 3

Glioma

Question 4

If a tumour arises from the meninges, what is it known as?

Answer 4

Meningioma

Question 5

If a tumour arises from the pituitary gland, what is it known as?

Answer 5

Adenoma

Question 6

Give some examples of common tumours which can spread to the brain.

Answer 6

Renal cell carcinoma
Lung carcinoma
Breast carcinoma
Malignant melanoma
GIT

Question 7

Which cells are gliomas derived from?

Answer 7

Astrocytes

Question 8

List some of the characteristics of meningiomas.

Answer 8

Slow growing
Usually benign
Extra-axial

Question 9

Where do meningiomas arise from?

Answer 9

Arachnoid

Question 10

How can pituitary tumours present?

Answer 10

Visual disturbances as compress the optic chiasm
Hormone imbalance

Question 11

What is the general clinical presentation for a brain tumour?

Answer 11

Raised intracranial pressure
Focal neurological deficit
Epileptic fits
CSF obstruction

Question 12

What are some of the symptoms suggesting raised intracranial pressure?

Answer 12

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

Question 13

What are some signs of raised intracranial pressure?

Answer 13

Papilloedema
6th nerve palsy
Cognitive impairment
Altered consciousness
3rd nerve palsy

Question 14

What needs to be done to reach a diagnosis of brain tumour?

Answer 14

History and examination
Think of secondary sources- e.g. CXR
CT
MRI
Biopsy

Question 15

List some focal neurological deficits.

Answer 15

Hemiparesis
Dysphasia
Hemianopia
Cognitive impairment
Cranial nerve palsy
Endocrine disorders

Question 16

A 66yr old, left handed women presents with ataxia and in-coordination. Where would you suspect there to be a lesion?

Answer 16

Cerebellum

Question 17

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?

Answer 17

Left parietal lobe

-> as right handed, left hemisphere is dominant

Question 18

Which syndrome occurs with left parietal lobe lesions?

Answer 18

Gerstmann’s syndrome

Question 19

A 30 yo, right handed man presents with a bitemporal hemianopia. Where would you suspect his lesion to be?

Answer 19

Pituitary gland

-> compresses on optic region

Question 20

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?

Answer 20

Left temporal parietal

->rib pain was due to bone metastasis btw

Question 21

Which areas of the brain are very epileptogenic?

Answer 21

Frontal and temporal

Question 22

What are the management goals for someone with a brain tumour?

Answer 22

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

Question 23

List some of the management options for brain tumours.

Answer 23

Corticosteroids e.g. dexamethasone to reduce oedema
Treat epilepsy
Analgesics
Surgery
Radiotherapy
Chemotherapy
Endocrine replacement

Question 24

Benign meningioma is curative, what can be done?

Answer 24

Surgical excision

Question 25

DO NOT DO A LUMBAR PUNCTURE WHEN THERE ARE SIGNS AND SYMPTOMS SUGGESTIVE OF A INTRACRANIAL MASS LESION.

Why?

Answer 25

-May cause meningitis
-May cause herniation syndrome and patient could die
-May cause air embolism
-May make headache worse