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Year 2 Neuro > Brain Tumours > Flashcards

Brain Tumours Flashcards

1
Q

Primary vs Secondary Brain Tumours

A

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

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2
Q

what are primary tumours of the neuroepithelial tissue?

A

Glioma (Glioblastoma mulitforme)

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3
Q

What are primary tumours of the meninges

A

meningioma

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4
Q

What are primary tumours of the pituatary

A

adenoma

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5
Q

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

A

Renal cell carcinoma
Lung carcinoma
breast carcinoma
malignant melanoma
GI tract

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6
Q

What are Gliomas

A

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

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7
Q

Grade IV Gliomas Characteristics

A

Most common
Most aggresive
Gliobstoma multiforme (Stage IV glioma)

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8
Q

How do Grade 4 Gliomas spread

A

Track through white mater and CSF pathway
very rarely spread systemically

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9
Q

What are Characteristics of Meningiomas

A

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

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10
Q

Where do meningiomas arise from?

A

Arachnoid mater

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11
Q

Characteristics of Pituatary tumours

A

Adenoma most common
Only 1% malignant

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12
Q

How do pituatary tumours present

A

Visual Disturbance: compression of optic chiasm.
Hormone imbalance

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13
Q

What are symptoms of Raised Intracranial pressure

A

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

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14
Q

What are the signs of raised ICP

A

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

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15
Q

What can cause hydrocephalous

A

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

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16
Q

What can tumours close to CSF pathway cause

A

Hydrocephalous

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17
Q

How much CSF is produced a day

A

400-450 cc/day

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18
Q

How to diagnose a brain tumour

A

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

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19
Q

What investigations would you carry out for brain tumours

A

CT
MRI
Biopsy

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20
Q

What are types of focal neurological deficits

A

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

21
Q

How many tumours are usually seen in primary vs secondary

A

Primary: usually one
Secondary: many

22
Q

what is the general presentation of brain tumours

A

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

23
Q

How much CSF is mainted in the body?

A

140-150ml, cycled 3x a day.

24
Q

What does papilloedema present as?

A

red
Blurred margins, optic disc isnt round.

25
Q

What is acalculia

A

Patient unable to carry out simple calculations

26
Q

What is agraphia

A

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

27
Q

What is agnosia

A

Loss of sensation

28
Q

What is Gerstmann’s syndrome

A

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

29
Q

Whats would be relevant to dysphasia

A

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

30
Q

What lesions can cause epilepsy?

A

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

31
Q

Investigations for primary Tumours

A

CT
MRI
PET
(angiography: vascular tumours)

32
Q

Investigation for suspecting metastasis

A

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

33
Q

What are the aims of managment of brain tumours

A

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

34
Q

Management for cerebral oedema

A

Corticosteroids: Dexamethasone

35
Q

Management of epilepsy

A

anticonvululsant drugs

36
Q

Management for pain and emotion

A

analgesics/antiemetics
counselling

37
Q

Management options

A

surgery
Radiotherapy
Chemotherapy
endocrine replacement (pituatory tumours)

38
Q

what chemotherapy is used in Gliobastoma multiforme

A

Temaxolamide

39
Q

What type of surgery is seen in Glioblastoma multiforme

A

Complete excision impossible: biopsy and debulk only

40
Q

What are the prognosis of primary tumours

A

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

41
Q

Prognonsis of metastases to brain

A

depends on primary - good, medium, remission

42
Q

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

A

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

43
Q

Why would you not do a Lumbar puncture

A

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

44
Q

Causes of Raised ICP

A

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

45
Q

What is an uncal herniation

A

Cerebrum moves inferiorly over the edge of tentorium

46
Q

What is coning

A

Cerebellum moves inferiorly into foramen magnum

47
Q

Signs and symptoms of SOL

A

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

48
Q

What happens as pressure increases

A

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

Year 2 Neuro (14 decks)

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