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Neurology > Brain Tumours > Flashcards

Brain Tumours Flashcards

1
Q

Commonest cause of cancer death under 40?

A

Brain tumours

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2
Q

Commonest cause of cancer death under 40?

A

Brain tumours

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3
Q

Describe the headaches in brain tumours: when are they worse? which position are they worse in? What are they associated with?

A
  • Worse in the morning
  • Worse leaning forward
  • May be associated and decrease with vomitting
  • Symptoms similar to tension HA/migraine
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4
Q

Cushings triad of raised ICP

A
  • irregular breathing
  • bradycardia
  • systolic hypertension
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5
Q

Which lobe:

  • thought
  • reasoning
  • behaviour
  • memory
A

Frontal lobe

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6
Q

Which lobe:

  • intellect
  • thought
  • reasoning
  • memory
A

Parietal lobe

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7
Q

Which lobe:

  • motor and sensory functions
  • abstract concepts
A

Motor and sensory functions: left

Abstract concepts: right

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8
Q

Which lobe:

  • Memory, hearing and vision pathways
  • Emotion
A

Temporal lobe

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9
Q

If you have metastases in the brain, what scan could you do to find the primary tumour?

A

PET scan

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10
Q

What establishes the diagnosis of glioblastoma multiforme?

A

The presence of necrosis (remember glioblatoma multiforme is grade IV)

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11
Q

Glial tumour arise from which cells?

A
  • glial cells

- oligodendrocytes

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12
Q

What age group are affected by grade 1 astrocytomas

A

Children, young adults

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13
Q

Where do pilocytic astrocytomas arise?

A
  • Optic nerve, hypothalamic gliomas

- Cerebellum, brainstem

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14
Q

Treatment for grade 1 astrocytomas

A

Surgery

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15
Q

Most common presentation of low grade glioma (low grade astrocytoma)

A

Seizure

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16
Q

Cellular features of a low grade astrocytoma

A
  • Hypercellularity
  • Pleomorphism
  • Vascular proliferation
  • Necrosis
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17
Q

Most common type of diffuse low grade astrocytoma

A

Fibrillary astrocytoma

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18
Q

Poor prognostic factors for low grade astrocytomas (fibrillary)

A
  • age >50
  • focal deficit (cf. seizures)
  • short duration of symptoms
  • raised ICP
  • altered consciousness
  • enhancement on contrast studies
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19
Q

What does IDH-1 or 1p19q indicate in grade II astrocytomas?

A

Better prognostic function

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20
Q

Treatment for low grade astrocytomas II?

A

Surgery +/- radiation/chemotherapy/combination

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21
Q

What is brachytherapy?

A

Placement of radioactive isotopes directly into the area to be treated

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22
Q

Poor prognostic factors for grade II astrocytomas (glioblastomas)

A
  • age >45
  • low performance score
  • large tumours (dia>6cm) / crossing midline
  • incomplete resection
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23
Q

Median survival for anaplastic astrocytoma

A

2 years

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24
Q

Median survival for glioblastoma multiforme?

A
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25
Q

How do glioblastoma multiforme spread?

A

White matter tracking / CSF pathways

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26
Q

How do you improve survival in malignant astrocytomas?

A
  • surgery +
  • radiotherapy +
  • TMZ (temozolomide)
  • improves survival to 14 months
  • live longer is MGMT methylated tumour
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27
Q

Significance of MGMT methylated tumour?

A

Live longer

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28
Q

Side effects of radiotherapy?

A

Drops IQ by 10
Skin
Hair
Tired

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29
Q

How do oligodendroglial tumours present?

A

Seizures

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30
Q

Which lobes do oligodendroglial tumours affect?

A

Frontal lobes

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31
Q

Age group affected by olgidendroglial tumours?

A

-25-45 years (smaller peak in children 6-12)

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32
Q

Oligodendroglial tumours are difficult to distinguish from astrocytomas, what can you look for? (CCP)

A
  • calcification
  • cysts
  • peritumoural haemorrhage
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33
Q

“toothpaste” morphology

A

Oligodendroglial tumours

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34
Q

What is a collision tumour?

A

Oligodendroglial cells can coexist with astrocytic cells in a neoplastic collision type of tumour

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35
Q

Which type of tumour is chemosensitive?

A

Oligodendroglial tumours

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36
Q

Treatment for oligodendroglial tumours

A

Chemotherapy (chemosensitive)

  • procarbazine
  • lomustine
  • vincristine
37
Q

Meningiomas arise from which type of cell?

A

Arachnoid cap cell

38
Q

Meningiomas arise from which type of cell?

A

Arachnoid cap cell

39
Q

Describe the headaches in brain tumours: when are they worse? which position are they worse in? What are they associated with?

A
  • Worse in the morning
  • Worse leaning forward
  • May be associated and decrease with vomitting
  • Symptoms similar to tension HA/migraine
40
Q

Cushings triad of raised ICP

A
  • irregular breathing
  • bradycardia
  • systolic hypertension
41
Q

Which lobe:

  • thought
  • reasoning
  • behaviour
  • memory
A

Frontal lobe

42
Q

Which lobe:

  • intellect
  • thought
  • reasoning
  • memory
A

Parietal lobe

43
Q

Which lobe:

  • motor and sensory functions
  • abstract concepts
A

Motor and sensory functions: left

Abstract concepts: right

44
Q

Which lobe:

  • Memory, hearing and vision pathways
  • Emotion
A

Temporal lobe

45
Q

If you have metastases in the brain, what scan could you do to find the primary tumour?

A

PET scan

46
Q

What establishes the diagnosis of glioblastoma multiforme?

A

The presence of necrosis (remember glioblatoma multiforme is grade IV)

47
Q

Glial tumour arise from which cells?

A
  • glial cells

- oligodendrocytes

48
Q

What age group are affected by grade 1 astrocytomas

A

Children, young adults

49
Q

Where do pilocytic astrocytomas arise?

A
  • Optic nerve, hypothalamic gliomas

- Cerebellum, brainstem

50
Q

Treatment for grade 1 astrocytomas

A

Surgery

51
Q

Most common presentation of low grade glioma (low grade astrocytoma)

A

Seizure

52
Q

Cellular features of a low grade astrocytoma

A
  • Hypercellularity
  • Pleomorphism
  • Vascular proliferation
  • Necrosis
53
Q

Most common type of diffuse low grade astrocytoma

A

Fibrillary astrocytoma

54
Q

Poor prognostic factors for low grade astrocytomas (fibrillary)

A
  • age >50
  • focal deficit (cf. seizures)
  • short duration of symptoms
  • raised ICP
  • altered consciousness
  • enhancement on contrast studies
55
Q

What does IDH-1 or 1p19q indicate in grade II astrocytomas?

A

Better prognostic function

56
Q

Treatment for low grade astrocytomas II?

A

Surgery +/- radiation/chemotherapy/combination

57
Q

What is brachytherapy?

A

Placement of radioactive isotopes directly into the area to be treated

58
Q

Poor prognostic factors for grade II astrocytomas (glioblastomas)

A
  • age >45
  • low performance score
  • large tumours (dia>6cm) / crossing midline
  • incomplete resection
59
Q

Median survival for anaplastic astrocytoma

A

2 years

60
Q

Median survival for glioblastoma multiforme?

A
61
Q

How do glioblastoma multiforme spread?

A

White matter tracking / CSF pathways

62
Q

How do you improve survival in malignant astrocytomas?

A
  • surgery +
  • radiotherapy +
  • TMZ (temozolomide)
  • improves survival to 14 months
  • live longer is MGMT methylated tumour
63
Q

Significance of MGMT methylated tumour?

A

Live longer

64
Q

Side effects of radiotherapy?

A

Drops IQ by 10
Skin
Hair
Tired

65
Q

How do oligodendroglial tumours present?

A

Seizures

66
Q

Which lobes do oligodendroglial tumours affect?

A

Frontal lobes

67
Q

Age group affected by olgidendroglial tumours?

A

-25-45 years (smaller peak in children 6-12)

68
Q

Oligodendroglial tumours are difficult to distinguish from astrocytomas, what can you look for? (CCP)

A
  • calcification
  • cysts
  • peritumoural haemorrhage
69
Q

“toothpaste” morphology

A

Oligodendroglial tumours

70
Q

What is a collision tumour?

A

Oligodendroglial cells can coexist with astrocytic cells in a neoplastic collision type of tumour

71
Q

Which type of tumour is chemosensitive?

A

Oligodendroglial tumours

72
Q

Treatment for oligodendroglial tumours

A

Chemotherapy (chemosensitive)

  • procarbazine
  • lomustine
  • vincristine
73
Q

Median survival for oligodendroglial tumours

A

-10 years

74
Q

Meningiomas arise from which type of cell?

A

Arachnoid cap cell

75
Q

Symptoms of meningioma

A

Headaches
Skull base: cranial nerve neuropathies
Regional anatomica disturbance

76
Q

CT findings of Meningioma

A

Homogenous, densely enhancing
Oedema
Hyperostosis / skull ‘blistering’

77
Q

MRI findings of meningioma

A

Dural tail

Patency of dural sinuses

78
Q

Why might you perform preoperative embolisation before surgery for meningioma?

A

Meningiomas are usually quite vascular so preoperative embolisation can ease complete tumour resection by diminishing operative time and intraoperative blood loss

79
Q

The classic angiographic appearance of
a _____ is that of increasing hypervascular tumor
blush throughout the arterial phase, persisting well into
the late venous phase with slow washout

A

Meningioma

80
Q

Age group affected by germ cell tumours?

A

90% affect those under 20

Peak incidence 10-12 years

81
Q

CT findings of germ cell tumours

A

ISO or HYPERdense

82
Q

How might germ cell tumours metastasise?

A

Via CSF

83
Q

What treatment are germinomas very sensitive to?

A

Germinomas are VERY radiosensitive

chemo second line, CIS-PLATIN has 80-100% response rate

84
Q

Tumour markers present in germinoma?

A

Beta HCG and PLAP

85
Q

Tumour markers present in teratoma?

A

AFP

86
Q

Tumour markers present in yolk sac tumour?

A

AFP and PLAP

87
Q

Tumour markers present in choriocarcinoma?

A

Beta HCG and PLAP

88
Q

Why might you give dexamethasone for brain tumours?

A

Can help to reduce the oedema

89
Q

Drugs you give post-operatively for seizure

A

Phenytoin and lorazepam (not diazepam as it stays in the fat, leaks out later and they stop breathing)

Neurology (56 decks)

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