Brain Tumours

Question 1

How do most people with an intracranial tumour present

Answer 1

Progressive neurological deficit - usually motor
Headache
Seizures (less common)

Question 2

What type of features suggest a headache may be due to a tumour

Answer 2

Worse in the morning or wakes them up
Worse with coughing or leaning forward
Vomiting- headache may feel better after vomiting
- can be v similar to a tension headache or migraine!

Question 3

What is the most common type of brain tumour

Answer 3

Metastases

Question 4

What are the signs of raised ICP

Answer 4

headache
vomiting
mental changes
seizures

Question 5

Why do people get a headache with a tumour?

Answer 5

raised ICP
invasion of dura, blood vessels, periosteum
secondary to diplopia
hypertension- cushings triad
psychogenic - stress due to loss of function

Question 6

What is cushings triad of raised ICP

Answer 6

a physiological nervous system response to increased intracranial pressure (ICP) that results in Cushing’s triad of increased blood pressure, irregular breathing, and a reduction of the heart rate

Question 7

What does the frontal lobe control

Answer 7

thought
reasoning
behaviour
memory

MOVEMENT- precentral gyrus

Question 8

What does the temporal lobe control

Answer 8

behaviour
memory
hearing and vision
emotion

Question 9

What is controlled in the parietal lobe

Answer 9

intellect
though reasoning memory

SENSATION- post cental gyrus

Question 10

what does the occipital lobe contol

Answer 10

in a right handed person

left- speech, motor and sensory
right-abstract thoughts

Question 11

What is a glioma

Answer 11

these are malignant tumours arising from the neuroepithelial tissie

Question 12

Name the most common tumour arising from neuroepithelial tissue

Answer 12

astrocytomas

Question 13

what Is an oligodendrogliomas

Answer 13

tumours arising from the oligodendrocytes

• slow growing over many decades
• calcification is common

Question 14

How are astrocytic tumours grades

Answer 14

1- pleomorphic xanthoastrocytome
2-low grade astrocytoma
3-anaplastic astrocytoma
4-glioblastoma multiforme

Question 15

what is the pathological hall mark of a glioblastoma

Answer 15

necrosis

Question 16

What is the prognosis of grade 1 astrocytomas

Answer 16

benign
slow growing
usually in children/young adults
surgery is curative

Question 17

What is the prognosis of grade 3 and 4 astrocytomas

Answer 17

Poor

2yrs for grade 3, 1 year for grade 4

Question 18

where are oligodendroglial tumours most commonly found

Answer 18

frontal lobes

Question 19

how do oligodendroglial tumours typically present

Answer 19

seizures

in adults aged 25-45yrs

Question 20

What is a collision tumour

Answer 20

oligodendroglial cells coexist with astrocytic cells in a neoplastic collision tumour

Question 21

What is the prognosis of a low grad oligodendroglial tumour

Answer 21

ten years

Question 22

What it she mainstay of treatment for oligodendroglial tumours

Answer 22

chemosensitive-
Surgery + chemo
radiotherapy used for seizure decrease but controversial

Question 23

What is a meningioma

Answer 23

a benign tumour arising from the arachnoid
may grow to a large size over may years
‘extra axial tumours’
usually asymmptomatic

Question 24

what conditions are menigiomas more common in

Answer 24

breast cancer

NF 2

Question 25

What are the classifications of menigiomas

Answer 25

classic
angioblastic
atypical- rare
malignant - rare

Question 26

Name the main nerve sheath tumours

Answer 26

Schwannomas ak neuromas
neurofibromas
malignant peripheral nerve sheath tumours

Question 27

what is an acoustic neuroma

Answer 27

a vestibular schannoma of the 8th cranial nerve

common in F2

Question 28

How do acoustic neuromas present

Answer 28

hearing loss
tinnitus
dysequibrium

Question 29

What age group are predominantly affected by germ cell tumours

Answer 29

less then 20 yrs

Question 30

How do germ cell tumours metastasise

Answer 30

via CSF

Question 31

What is the most common CNS germ cell tumour

Answer 31

germinomas

Question 32

How are germinomas treated

Answer 32

radiosensitive (only give if over the age of three)

good 5 yr survival rate

Question 33

Name other types of non germinomatous germ cell tumours

Answer 33

teratoma
yolk sac tumour
choriocarcinom
embryonal carcinoma
these are all less radiosensitive --> poor prognosis

Question 34

What tumour markers are present in yolk sac tumours (and teratomas)

Answer 34

Alpha fetoprotein

Question 35

What tumour markers are present in choriocarcinomas

Answer 35

human choriogonadotropin
(beta-HCG)
also present in germinomas

Question 36

What is the tumour marker for a germinoma

Answer 36

PLAP - placental alkaline phosphatase