Brain tumours Flashcards
What are some conditions that can increase risk of brain tumours
NF
VHL
Tuberose sclerosis
Li-Fraumeni syndrome
What causes headache in brain tumour?
- Raised ICP
- Invasion/compression of dura, BVs or periosteum
- Secondary to diplopia (CN III, IV,VI; INO)
- Secondary to difficulty focusing
- Extreme hypertension
- Psychogenic (stress of loss of functional capacity)
Neurological signs of anterior frontal lobe tumours
Conscious though, reasoning, behaviour and memory impairment
Neurological signs of inferior frontal lobe tumours
Smell dysfunction
Neurological signs of pre-central gyrus tumour
Movement dysfunction (related to homunculus)
Neurological signs of post-central gyrus tumour
Sensory dysfunction (Related to homunculus)
Neurological signs of anterior temporal lobe tumours
Behaviour, memory, hearing, vision and emotional dysfunction
Neurological signs of left posterior temporal lobe tumours?
Speech, motor and sensory dysfunction
Neurological signs of right posterior temporal lobe tumours?
Dysfuction in abstract concept understanding
DANISH signs of cerebellar disease
D - Dysdiadochokinesia
A - Ataxia
N - Nystagmus
I - Intention tremor
S - Slurred speech
H - Hypotonia
Neurological signs of occipital lobe tumour
Vision defects
Forms of high-grade brain tumours
- Gliomas and glioblastoma multiforme
- Primary cerebral lymphomas
- Medulloblastomas
Forms of low-grade brain tumours
- Meningiomas
- Acoustic neuromas
- Pituiary tumours
- Pineal tumours
- Craniopharyngiomas
- Neurofibromas
What is a glioma
A tumour of the glial cells of the brain or spinal cord
How many grades of glioma are there?
4
1 is the most benign, 4 is the most malignant
Pilocytic astrocytoma is a grade … glioma
1 (>10 year survival)
Low grade glioma is a grade … glioma
2 (10-12 year survival)
Anapaestic astrocytoma is a grade … glioma
3 (2-5 year survival)
Glioblastoma multiforme is a grade … glioma
4 (12-18 month survival)
What are meningiomas?
Tumours arising from the cells of the meninges surrounding the brain and spinal cord
How do meningiomas cause problems?
They are usually benign but cause problems via mass effect
What is an acoustic neuroma?
A benign tumour of the schwann cells surrounding the auditory (Vestibulocochlear) nerve
What is another term for acoustic neuroma?
Vestibular schwannoma
Where do acoustic neuromas usually occur?
Unilaterally at the cerebellopontine angle
What disease is bilateral acoustic neuroma associated with?
NF2
Who is most at risk of acoustic neuroma?
Those age 40-60
How does acoustic neuroma present?
- Unilateral sensorineural hearing loss(often the first symptom)
- Unilateral tinnitus
- Dizzinessorimbalance
- Sensationoffullnessin the ear
- Facial nerve palsy(if the tumour grows large enough to compress the facial nerve)
How may acoustic neuroma be managed?
- Conservative
- Surgery
- Radiotherapy
What is a medulloblastoma?
A common, malignant tumour of children, arising from the cerebellar stem cells, which seeds in the CSF pathways
What are some symptoms of medulloblastoma?
Hydrocephalus
Cerebellar signs (DANISH)
Mass effect symptoms
Extra-ocular muscle palsy
What investigations are required to diagnose medulloblastoma?
Lumbar puncture
MRI
CT head and spine
How may medulloblastoma be managed?
- Surgery
- Radiotherapy
- Chemotherapy
What are some global symptoms of brain tumours?
- Headache
- Nausea and vomiting
- Reduced GCS
- Pupillary defect
What are some focal symptoms of brain tumours?
- Paresis
- Dysphasia
- Numbness
- Seizure
- Visual symptoms
- Dyscoordination
- Motor weakness
Describe a typical brain tumour headache
Worse in the morning (May wake them up)
Worse with coughing and leaning forward
associated with vomiting
Symptoms of migraine
What are the 5 points of performance scoring (PS)?
- 0 - Normal activity
- 1 - Symptomatic and ambulatory, cares for self
- 2 - Ambulatory >50% of the time, occasional assistance
- 3 - Ambulatory ≤50% of the time, nursing care needed
- 4 - Bedridden
What are the most common tumours that metastasise to the brain?
Lung
Breast
Skin (Melanoma)
Kidney
How is cerebral oedema surrounding a tumour managed?
Steroid therapy
Management options for brain tumours
Neurosurgical resection
Stereotactic radiotherapy
Whole-brain radiotherapy
Chemotherapy (Palliative)
