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Neurology > Brain tumours > Flashcards

Brain tumours Flashcards

1
Q

What are the 3 cardinal signs of a brain tumour?

A

Raised intracranial pressure

Progressive neurological deficit

Epilepsy

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2
Q

What are some symptoms of raised ICP?

A

Drowsiness
Headache
Nausea + vomiting
Papilloedema

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3
Q

Why does a brain tumour cause raised ICP?

A

There is a mass growing in your head, inside a non-expandable box (skull)

So any expanding causes raised pressure

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4
Q

As a brain tumour increases in size, ICP rises proportionally.

True or false? Why?

A

False

The brain is like a sponge, so it is compressible to a certain extent
But it will hit a point when it can’t compress anymore and pressure will rise

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5
Q

Why does raised ICP result in coma?

A

Compression of brain stem

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6
Q

Why does raised ICP cause death?

A

Compression of brainstem cuts of vascular supply to the brain
Cerebral infarction = death

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7
Q

What are the features of a headache caused by raised ICP?

A

Headache is present in the morning and is worse at this time

Worsened by coughing, straining, bending forwards

Can be relieved by vomiting

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8
Q

What is a colloid cyst?

A

A cyst containing gelatinous material found in the brain

Almost always found in the 3rd ventricle

Can be fatal very quickly

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9
Q

What is so bad about a colloid cyst?

A

Occur in the 3rd ventricle
They can block flow of CSF out of the lateral ventricles

Acute hydrocephalus develops

Which can kill in hours

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10
Q

What are the clinical features of a colloid cyst?

A

Raised ICP headache

  • worse on waking
  • increased by coughing, straining
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11
Q

Investigations of colloid cyst?

A

CT scan, shows up white on a scan.

Usually small and in centre of the brain (3rd ventricle)

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12
Q

What is papilloedema?

A

Optic disc swelling caused by raised ICP

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13
Q

How can you check if someone has papilloedema?

A

Look at their optic discs

You should see yellow-ish centre that looks uneven
Plus haemorrhages + dilated blood vessels

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14
Q

What is meant by focal neurological deficit?

A

Signs shown by a patient that indicate damage has occurred to a specific part of the brain

I.e.

Gait problems caused by a lesion in frontal lobe

Deafness caused by a lesion in the temporal lobe

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15
Q

What are some common focal neurological deficits seen with brain tumours?

A

Motor deficit

Sensory deficit

Speech deficit: expressive, receptive, both

Visual deficit

Deafness

Deteriorating memory

Personality change

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16
Q

When should you consider a brain tumour as a cause of epilepsy?

A

If the epilepsy is recent onset in an adult

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17
Q

What types of epilepsy do brain tumour patients often get?

A

Allsorts

Motor
Sensory
Temporal lobe

Plus
Olfactory aura, deja vu, transient funny sensation in stomach

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18
Q

What two categories of brain tumour are there?

A

Primary

Secondary (from a metastasis)

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19
Q

Are primary or secondary brain tumours more common?

A

Secondary

20
Q

What are the most common sites from which brain metastases originate from?

A

Lung cancer: small cell or non-small cell

Breast
Melanoma
Renal cell
GI

21
Q

Lower GI cancer tends to metastasis to which part of the brain?

What about upper GI cancer?

A

Lower GI to lower brain, cerebellum

Upper GI to upper brain

22
Q

What cell type do most primary brain tumours originate from?

A

Glial cell

23
Q

What is a glial cell?

A

Surround neurons and provide support for and insulation between them

24
Q

Name some types of glial cell?

A

Astrocytes
Oligodendrocytes
Schwann cells
Ependymal cells

25
Q

What is the grading system for gliomas?

A

The WHO grading system

Grade 1: pilocytic astrocytoma

Grade 2: diffuse astrocytoma

Grade 3: anaplastic astrocytoma: malignant

Grade 4: gliobastoma multiforme (GBM): cancer, common, fast growing

26
Q

What does GBM stand for?

A

Glioblastoma multiforme

27
Q

Describe some features of GBM?

A

Malignant
Most common one seen
Grows so fast it gets necrotic

28
Q

What happens to gliomas if they are given enough time and not much treatment?

A

All gliomas develop into GBM eventually

29
Q

Management of a glioma?

A

Surgery: debulking, in progression for radiotherapy

Analysis of the tumour to grade it

Treatment of hydrocephalus if there is any

Radio + chemotherapy

Dexomethasone

Palliative care

30
Q

Why is excising gliomas usually quite difficult?

A

They are usually irregular shaped, so it is easy to miss a bit

31
Q

How can you treat acute hydrocephalus?

A

Ventriculo-peritoneal shunt

32
Q

What is a ventriculo-peritoneal shunt?

A

A tube that runs from CSF space down the peritoneum where it can be reabsorobed

33
Q

What is dexamethasone?

A

A type of chemotherapy, a very powerful steroid

It is an artificial version of hydrocortisone

It reduces oedema and tumour inflammation

34
Q

Why should you not give a dose of dexamethasone after lunchtime?

A

It is a drug that makes you really awake, because it is a replacement for hydrocortisone

So if you take it too late you won’t sleep that night

35
Q

What happens to patients when they are at the very late stage of brain tumour?

A

They slow down

Spending more time asleep

Become disinterested in life, other people

36
Q

How can benign gliomas cause problems? What damage/complications can they cause?

A

Transformation to malignancy

Progressive mass effect due to slow tumour growth

Progressive neurological deficit as brain is destroyed by tumour

37
Q

What is glioma?

A

An umbrella term for tumours of glial cells

38
Q

What is an oligodendroglioma?

A

A tumour of oligodendrocytes

A type of glioma

39
Q

What is a drug used to treat GBM?

A

Temozolomide

It improves survival

40
Q

Temozolomide - what is it used for?

What can you do to make it work better?

A

Used to treat GBM

Debulk the tumour first

41
Q

Who gets benign gliomas?

A

Young people, in their 20s and 30s

42
Q

What is the prognosis for benign glioma?

A

Not good

Median survival of 5-7 years

43
Q

What treatments are there for benign glioma?

A

Not a lot

Chemo, radiotherapy and surgery have not been proven to be beneficial

44
Q

What is the relationship between a benign glioma and GBM?

A

Benign gliomas progress to GBMs in time

45
Q

Is it better to have a benign glioma or an oligodendroglioma?

A

Oligodendroglioma

The life expectancy is 10-15 years rather than the 5-7 it is for benign glioma

46
Q

Do oligodendrogliomas become malignant?

A

Yes, they become anaplastic

Occasionally they progress to GBM

Neurology (23 decks)

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