Brain tumours Flashcards
general presentation? (4)
progressive neurological deficit
usually motor weakness
headache- reissued ICP
seizures
raised ICP
- due to?
- symptoms? (4)
-tumour mass/oedema mass effect
Blockage of CSF flow (hydrocephalus)
haemorrhage
-Headaches
Vomiting
Mental changes
seizures
Headache
- features?
- why do they occur with tumour? (5)
worse in the morning e.g. wakes them up
increased with coughing/leaning forward
May be associated with vomiting
OR migraine symptoms
-raised ICP Invasion/compression of dura, BVs, periosteum diplopia/difficulty focusing extreme hypertension psychogenic
Neurological signs -correlate to what? -what would be expected with a tumour in the following areas: frontal lobe? parietal lobe? occipital lobe? cerebellum? Temporal lobe? -when should a patient be referred?
location of tumour
-changes to:
thought, reasoning, behaviour, memory, smell, movement
changes to:
intellect, thought, reasoning, memory, intellect, hearing, sensation
changes to:
L: speech, motor, sensory
R: abstract concepts
+vision
Changes to:
balance & coordination (DANISH)
changes to:
Behaviour, memory, hearing, vision pathways, emotion
-focal neurological deficit
Change in behaviour
Seizure
headache
What investigations should be carried out?
CT MRI LP (not in raised ICP) PET Lesion biopsy EEG evoked potentials angiograms radio nucleotide studies
name the different classifications of brain tumour that can occur? (10)
Meninges Nueroepthilieal tumour Nerve sheath cell Developmental lesions Sella lesions Germ cells Local extension from adjacent structures Haemopoietic/lymphomas mets
Neuroepithelial tissue
-what cells are involved? (6)
-astrocytes, oligodendroglial cells Ependymal cells/choroid plexus Neuronal cells Pineal cells Embryonic
What are the grades of astrocytic tumours? (3)
I- pilocytic, pleomorphic xanthoastrocytoma sub ependymal giant cell
II- low grade astrocytoma
III- Anaplastic astrocytoma
IV- glioblastoma multiforme
Grade 1 astrocytomas
- features? (3)
- examples?
- treatment?
- MRI?
-Truly benign
Slow growing
Children, young adults
-Pilocytic astrocytomas
-optic nerve, hypothalamic gliomas
Cerebellum, brainstem
-surgery
Low grade astrocytoma (i.e. grade 2)
- types? (3)
- progression? (4)
- preferential location? (3)
- presentation? (1)
- poor prognostic factors?
- treatment of grade 2?
- fibrillary, gemistocytic, protoplasmic
- hypercellularity -> pleomorphism -> vascular proliferation -> Necrosis
- temporal lobe, Post frontal, ant parietal
- seizures
-age > 50 Focal deficit Short duration of symptoms Raised ICP Altered consciousness Enhancement on contrast
-radiation
chemo
combined chemo/radio
+surgery
Glioblastoma surgery
- types?
- reasons for surgery?
- poor prognosis? (4)
- stereotactic OR open
- seizure control, herniation, CSF obstruction, cytoreduction
-age>45
low performance score
large tumours
incomelete resection
Malignant astrocytomas (III-IV)
- types (2)
- fetaures and survival?
- treatment?
- what is the Stupp protocol?
- prognosis?
- chemo drugs used? (5)
- when is radiotherapy used?
Anaplastic astrocytoma
can arise de novo
median survival 2 yrs
Glioblastoma multiforme
spreads into white matter tracking CSF pathways
survival 12-14 months
multiple occur in NF, TS, PML
-noncurative surgery:
survival quality increase
surgery: cytoreduction & reduce mass effect
post opp radiotherapy
-radiotherapy
total 60 Gy
2 Gy per daily fraction (Monday to Friday) over 6 weeks
temozolomide
during radiotherapy: 75 mg per square meter of body-surface area per day, 7 days per week
post-radiotherapy (adjuvant): six cycles consisting of 150-200 mg per square meter for 5 days during each 28-day cycle
-live longer if an MGMT methylates tumour
-Temozolomide
PCV (Procarbazine, CCNU, vincristine)
Carmustine wafer
-post surgery
Oligodendroglial tumours
- occur where?
- in what age group?
- presentation?
- distinguishing features?
- grading?
- treatment? (3)
- chemo drugs?
- frontal lobes
- adults 25-45 yrs
- seizure
-calcification
Cysts
peritumoral haemorrhage
Collision tumours (oligodendrocytes co exist with astrocytes in neoplastic collision)
-low grade to anaplastic
-Chemosensitive
Surgery, Chemo
Radio decreases surgery
-Procarbazine, Lomustine, Vincristine
Meningiomas
- what are meningeal cells?
- location?
- what as a meningioma en plaque?
- name according to position? (4)
- symptoms?
- classification?
- name the most aggressive tumours? (4)
- pre op evaluation should include? (3)
- treatment?
- arachnoid cap cells
- outside the parenchyma i.e. extra-axial
- subgroup within the meningiomas defined by a carpet or sheet-like lesion that infiltrates the dura and sometimes invades the bone
-parasagittal
Convexity
Sphenoid
Intraventricular
-headache
Skull base: CN neuropathies
Regional anatomical disturbance
-classic
Angioblastic
Atypical
Malignant (5%)
-Clear cell Choroid Rhabdoid Papillary radiation induced/after childhood leukaemia
-CT
homogenous, densely enhancing
Oedema
Hyperostosis
MRI
dural tail
potency of dural sinuses
Angiography
external carrot artery feeders
occlusion of sagittal sinus
-pre-op embolisation
surgery
radiotherapy
Nerve sheath tumours
-name the 3 types?
-Schwannomas (neuromas)
Neurofibromas
Malignant peripheral nerve sheath tumours
