Brain tumours

Question 1

What is the most common extra-axial tumour?

Answer 1

Meningioma

Question 2

What are some other extra-axial tumours?

Answer 2

Pituitary adenoma
Craniopharyngioma
Choroid plexis papilloma
Acoustic neuroma

Question 3

How do brain tumours present?

Answer 3

Progressive neurological defecit:

• headache
• seizures
• motor weakness

Question 4

How do brain tumours cause raised ICP and how would this present?

Answer 4

Brain tumour mass or surrounding oedema blocks CSF circulation
Presents as seizures, headaches, vomiting, mental changes

Question 5

How does a headache associated with tumour present?

Answer 5

Worse in the morning; wakes them up
Worse with coughing / leaning forward (30%)
May be associated with vomiting
May be associated with diplopia or difficulty focusing

Question 6

What cells do glial tumours arise from?

Answer 6

Astrocytes or oligodendrocytes

Question 7

What is the progressive malignant scale of glial tumour?

Answer 7

Low grade astrocytoma
Anaplastic astrocytoma
Glioblastoma multiforme

Question 8

Who gets grade 1 astrocytomas?

Answer 8

Children and young people

Question 9

What is the best treatment for grade 1 astrocytomas?

Answer 9

Surgical removal

Question 10

Are grade 1 astrocytomas benign or malignant?

Answer 10

Benign

Question 11

Where are pilocytic astrocytomas found?

Answer 11

Optic nerve
Hypothalamic gliomas
Cerebellum
Brainstem

Question 12

How do low grade astrocytomas present?

Answer 12

Seizures

Question 13

What are poor prognostic factors with low grade astrocytomas?

Answer 13

Age >50
Focal deficit (complex focal seizures)
Short duration of symptoms
Raised ICP
Altered consciousness
Enhancement on contrast studies

Question 14

Where are low grade astrocytomas commonly found?

Answer 14

Temporal lobe
Posterior Frontal
Anterior Parietal

Question 15

What are the malignant astrocytomas?

Answer 15

Anaplastic astrocytoma

Glioblastoma multiforme

Question 16

Where do oligodendral tumours occur?

Answer 16

Frontal lobes

Question 17

Who gets oligodendral tumours?

Answer 17

Adults 25-45 years

Question 18

How do oligodendral tumours present?

Answer 18

Seizures

Question 19

How are oligodendral tumours treated?

Answer 19

Surgery and chemotherapy

Question 20

How are malignant astrocytomas treated?

Answer 20

Non-curative surgery
Radiotherapy
Some chemotherapy

Question 21

What are meningiomas?

Answer 21

Tumours arising from the arachnoid “cap” cells of the arachnoid villi in the meninges

Question 22

Are meningiomas benign or malignant?

Answer 22

Most meningiomas are benign, but a small percentage are malignant

Question 23

Which meningiomas are malignant?

Answer 23

Clear cell
Chordoid
Rhabdoid
Papillary
Radiation induced meningiomas

Question 24

What are the symptoms of meningioma?

Answer 24

Focal seizures
Spastic weakness
Diplopia
Increased ICP

Question 25

What tumour condition are vestibular schwannomas associated with?

Answer 25

Neurofibromatosis type 2

Question 26

At what age do germ cell tumours occur?

Answer 26

Mostly under 20, peak incidence 10-12 years old

Question 27

What is the most common CNS germ tumour?

Answer 27

Germinoma

Question 28

How are germinomas managed?

Answer 28

They are radiosensitive, so mainstay of therapy is with radiation

Question 29

What tumour marker will be present in germinoma?

Answer 29

Placental alkaline phosphatase (PLAP)