Brain tumours Flashcards
Presentation of brain tumour
Progressive neurological deficit Usually motor weakness Headache Seizures Vomiting Mental changes
If you have a brain tumour, when is your headache worst? What aggravates it?
Worse in the morning (patient will wake up with it)
Worse when coughing/leaning forward (30%)
May be associated with vomiting
(OR symptoms similar to tension headache/migraine)
Most common extra-axial tumour
Meningioma
What is cushing’s triad?
Can occur because of increased ICP:
- bradycardia
- irregular respirations (impaired brainstem function)
- widening pulse pressure
(widening pulse pressure is caused by increased difference between systolic and diastolic pressure over time)
DANISH
dysdiadochokinesis ataxia (cerebellar) nystagmus intention tremor scanning dysarthria heel-shin test
Dysarthria
Difficulty in articulating speech
Why might you need to do PET scan?
Can be used to locate primary tumour if metastases in the brain
What do radionucleotide studies show?
Can show abnormal tissue growths like tumour and can also show you how the organ is functioning
Where do pilocytic astrocytomas arise?
Optic nerve, hypothalamic gliomas
Cerebellum, brainstem
What age group affected by pilocytic astrocytomas?
Children, young adults
What are pilocytic astroytomas?
Low grade, usually benign tumours
Affect children and young adults
Treatment for pilocytic astrocytomas
Surgery
Curative
Most common type of low grade astrocytoma
Fibrillary astrocytoma
Low grade astrocytoma site predilication
Temporal lobe
Posterior frontal lobe
Anterior parietal lobe
Presentation of low grade astrocytomas
Seizures
Poor prognostic factors of low grade astrocytomas
Age >50 Focal deficit ( cf. seizures) Short duration of symptoms Raised ICP Altered consciousness Enhancement on contrast studies
What molecular profiles of grade II astrocytomas have a better prognosis?
IDH-1
1p19q
Treatment for grade II astrocytomas
Sugery +/- chemo/radio depending on molecular profile
Poor prognostic factors for a grade II gliomablastoma?
Poor prognosis:
- Age >45
- Low performance score
- Large tumors (dia. >6cm) / crossing midline
- Incomplete resection
Median survival if you have an anaplastic astrocytoma?
2 years
Median survival of glioblastoma multiforme?
How do glioblastoma multiformes spread?
White matter tracking/ CAF pathways
Treatment for malignant astrocytomas (grade III/IV)
Non-curative surgery - focusses on survival quality
In malignant astrocytomas, givine surgery PLUS radiotherapy PLUS chemo improves survival by how much?
14 months
