Brain Tumours Flashcards
In what circumstances in surgery indicated for brain mets?
Symptomatic relief
Removal of a solitary secondary if the primary is well controlled
If the solitary met is in a easily assessible sight
What feature is common in oligodendroglioma’s that helps with there indentification on CT?
Calcification
Presentation with a visual field defects means the mass is likely to be where?
Temporal
Parietal
Occipital
Aproximately over what time period to GBM arise?
Weeks to a few months
How do low and high grade gliomas differ in appearance on CT? (mention the effect of contrast)
Low grade typically hypodense and non-enhancing with little surround oedema
High grade typically enhance vividly, in a patchy manner with an irregular rim and oedema and necrosis
What percentage of patients with cerebral astrocytomas have seizures?
50-75% of all patients
How do glioblastoma multiforme appear on MRI?
Heterogenous
Invasive
“eating away at the brain”
Not well circumscribed
How are metastases treated?
Steroids
Surgery
Radiotherapy
Anticonvulsants
Tumours that cause seizures are more likely to occur where in the brain?
Paracortex
What is the adjuvant therapy to surgery for gliomas?
Local radiotherapy
A tumour arising in one of the ventricles, what do you think of?
Ependymoma
What are some common presenting symptoms of brain tumours?
Headache
Seizures
Focal neurological deficits
Mood/personality changes
Nausea and vomiting
Why are raised ICP headaches worse in the morning?
Lying down reduces venous drainage in the brain
You hypoventilate during sleep > Hypocapnoea > Cerebral vasodilation
Where in the brain do mets often lie?
In the distribution of the MCA
Which cancer’s commonly send mets to the brain?
Lung
Breast
Kidney
Melanoma
GIT
What are the characteristic features of a raised ICP headache?
Present upon waking
Associated with vomiting and relieved by it
Not localised to any point in the brain
What is the most common primary brain tumour?
Gliomas namely, an astrocytoma and particular glioblastoma multiform
What are the principles of management of a brain tumour?
Dexathasone to reduce inflammation
Resect as much as possible
Adjuvant therapy - Radiation or chemotherapy
What is the Monro-Kellie doctrine?
The cranial is a fixed cavity with little ability for increasing the volume of its content
What is the most important symptom of raised ICP? Why?
Drowsiness
Implies impending deterioration
What factors determine prognosis of a brain tumour?
Age of patient (particularly >65)
Severity of neurological symptoms
Grade of tumour
Degree of surgical removal
Which inherited disease puts people at increased risk of developing brain cancers?
Von Recklinghausen’s
Neurofibromatosis 1 and 2 (multiple tumour types occur)
Li Fraumeni syndrome (p53 loss predisposes to glioma)
What are the gliomas’?
Astrocytoma
Oligodendrocytoma
Ependymoma
Medulloblastoma
What is the classic histological features of a glioblastoma multiform?
Pallisading at the margin
Few normal astrocytes
Necrosis
What are the most common tumours in the posterior fossa of adults?
Mets (95%)
Haemangioblastoma
Astrocytomas and medulloblastomas
Which chemotherapy agent is often used for adjuvant therapy for malignant astrocytomas?
Temozolomide
What is myokymia?
Benign twitching of a few muscles in a group
What is the histopathological appearance of memingiomas?
Whirls
