Brain Tumours

Question 1

Primary vs Secondary Brain Tumours

Answer 1

Primary: origin of tumour
Secondary: tumour has metastised to the brain

Question 2

what are primary tumours of the neuroepithelial tissue?

Answer 2

Glioma (Glioblastoma mulitforme)

Question 3

What are primary tumours of the meninges

Answer 3

meningioma

Question 4

What are primary tumours of the pituatary

Answer 4

adenoma

Question 5

What are the most commo types of tumours to metastise to the brain

Answer 5

Renal cell carcinoma
Lung carcinoma
breast carcinoma
malignant melanoma
GI tract

Question 6

What are Gliomas

Answer 6

derived from astrocytes: provides structural and nutritional support to nerve cells
Graded: 1-4
Grade 4 most common

Question 7

Grade IV Gliomas Characteristics

Answer 7

Most common
Most aggresive
Gliobstoma multiforme (Stage IV glioma)

Question 8

How do Grade 4 Gliomas spread

Answer 8

Track through white mater and CSF pathway
very rarely spread systemically

Question 9

What are Characteristics of Meningiomas

Answer 9

Slow growing
Extra-axial
Usually bening
Arise from arachnoid
Frequently occur along: Sphenoid, Falx, convexity
Usually cured if completely removed

Question 10

Where do meningiomas arise from?

Answer 10

Arachnoid mater

Question 11

Characteristics of Pituatary tumours

Answer 11

Adenoma most common
Only 1% malignant

Question 12

How do pituatary tumours present

Answer 12

Visual Disturbance: compression of optic chiasm.
Hormone imbalance

Question 13

What are symptoms of Raised Intracranial pressure

Answer 13

Headache (typically morning headache)
Nausea/vomiting
visual disturbance
somnolence (drowsiness)
cognitive impairment
altered consciousness

Question 14

What are the signs of raised ICP

Answer 14

Papilloedema
6th cranial nerve palsy
cognitive impairment
altered consciousness
3rd nerve palsy

Question 15

What can cause hydrocephalous

Answer 15

Tumours in or close to csf pathways
esp. posterior fossa tumours
esp. in children

Question 16

What can tumours close to CSF pathway cause

Answer 16

Hydrocephalous

Question 17

How much CSF is produced a day

Answer 17

400-450 cc/day

Question 18

How to diagnose a brain tumour

Answer 18

History + examination
Think of sources of secondary tumours
CT
MRI
biopsy

Question 19

What investigations would you carry out for brain tumours

Answer 19

CT
MRI
Biopsy

Question 20

What are types of focal neurological deficits

Answer 20

hemiparesis
dysphasia
hemianopia
cognitive impairment (memory, sense of direction)
Cranial nerve palsy
endcrime disorders

Question 21

How many tumours are usually seen in primary vs secondary

Answer 21

Primary: usually one
Secondary: many

Question 22

what is the general presentation of brain tumours

Answer 22

Raised Intracranial Pressure (mass effect)
Focal neuorlogical deficit
epileptic fits
CSF obstruction

Question 23

How much CSF is mainted in the body?

Answer 23

140-150ml, cycled 3x a day.

Question 24

What does papilloedema present as?

Answer 24

red
Blurred margins, optic disc isnt round.

Question 25

What is acalculia

Answer 25

Patient unable to carry out simple calculations

Question 26

What is agraphia

Answer 26

Loss of ability to communicate through writing or an inability to spell

Question 27

What is agnosia

Answer 27

Loss of sensation

Question 28

What is Gerstmann's syndrome

Answer 28

Right-left confusion Damage to left (dominant) parietal lobe Difficulty: writing, maths, distinguishing left and right, finger agnosia

Question 29

Whats would be relevant to dysphasia

Answer 29

difficulty reading emails difficulty expressing what they would like to say Short term-memory impairment

Question 30

What lesions can cause epilepsy?

Answer 30

Lesions above the tentorium Most likely in Frontal or temporal lobes First fit: 20% of tumour

Question 31

Investigations for primary Tumours

Answer 31

CT MRI PET (angiography: vascular tumours)

Question 32

Investigation for suspecting metastasis

Answer 32

CT chest/abdo/pelvis Mammography Biopsy skin lesions/lymph nodes

Question 33

What are the aims of managment of brain tumours

Answer 33

Accurate tissue diagnosis Improve QoL (decreasing mass effect, improve neurological deficit) aid affect of adjuvant therapy prolong life expectancy

Question 34

Management for cerebral oedema

Answer 34

Corticosteroids: Dexamethasone

Question 35

Management of epilepsy

Answer 35

anticonvululsant drugs

Question 36

Management for pain and emotion

Answer 36

analgesics/antiemetics counselling

Question 37

Management options

Answer 37

surgery Radiotherapy Chemotherapy endocrine replacement (pituatory tumours)

Question 38

what chemotherapy is used in Gliobastoma multiforme

Answer 38

Temaxolamide

Question 39

What type of surgery is seen in Glioblastoma multiforme

Answer 39

Complete excision impossible: biopsy and debulk only

Question 40

What are the prognosis of primary tumours

Answer 40

Meningioma: commonly cured by surgery, may require anticonvulsants Astrocytomas (gliomas) low grade: long life expectancy high grade: average 1 yr survival

Question 41

Prognonsis of metastases to brain

Answer 41

depends on primary - good, medium, remission

Question 42

Should you do a lumbar puncture in someone with suspected brain mass

Answer 42

No Do not perform when there are signs and symptoms for an intracranial mass lesion

Question 43

Why would you not do a Lumbar puncture

Answer 43

You might cause: Meningitis Herniation syndrome air embolism make patients headache worse

Question 44

Causes of Raised ICP

Answer 44

localised lesions: tumour, haemorrhage, abscess (Space occupying) Generalised pathologies: Oedema post trauma

Question 45

What is an uncal herniation

Answer 45

Cerebrum moves inferiorly over the edge of tentorium

Question 46

What is coning

Answer 46

Cerebellum moves inferiorly into foramen magnum

Question 47

Signs and symptoms of SOL

Answer 47

Squeeze on cortex + brainstem: MORNING headache and sickness Squeeze on optic nerve: papilloedema

Question 48

What happens as pressure increases

Answer 48

Pupillary dilation: cranial nerve 3 palsy Falling GCS Brain stem death --> squeezing downwards of cerebellum into foramen magnum (crushing of brainstem):patient is dead