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Systems: Neurology AB > Brain Tumours > Flashcards

Brain Tumours Flashcards

1
Q

What are the WHO classifications of CNS tumours?

A
  • Tumours of neuroepitheal tissue
  • Tumours of meninges
  • Tumours of cranial and spinal nerves
  • Haematopoietic neoplasms
  • Germ cell tumours
  • Cysts and tumour-like lesions
  • Tumours of the sellar region
  • Local extensions from regional tumours
  • Metastatic tumours
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2
Q

What are the commonest tumours that spread to the brain?

A
  • Renal cell carcinoma
  • Lung carcinoma
  • Breast carcinoma
  • Malignant melanoma
  • GI tract
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3
Q

What are common types of primary brain tumours?

A
  • Gliomas
  • Meningiomas
  • Adenomas
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4
Q

What is the most common type of brain tumour seen clinically?

A

Metastatic disease

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5
Q

What percentage of cancer patients will have cerebral metastases?

A
  • 15-30% patients with cancer will get cerebral metastasis
  • 15% cerebral metastasis is presenting symptom
  • 9% cerebral met is only detectible site of spread
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6
Q

What ae gliomas derived from?

A

Astrocytes

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7
Q

What are astrocytes?

A

Structural and nutritional support to nerve cells

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8
Q

What is the most common grade of gliomas?

A

Grade IV

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9
Q

What are the features of grade IV glioblastomas?

A
  • Most common
  • Most aggressive
  • Spread by tracking through white mater and CSF pathway
  • Very rarely spread systemically
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10
Q

What do meningiomas arise from?

A

Arachnoid matter

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11
Q

Where do meningiomas frequently occur?

A
  • Frequently occur along falx, convexity or sphenoid bone

- Extra-axial

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12
Q

How fast do meningiomas grow?

A

Slow growing

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13
Q

What type of tumours are meningiomas?

A

Usually benign

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14
Q

How are meninigiomas cured/

A

Usually cured if completely removed

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15
Q

What is the most common pituitary tumour?

A

Adenoma

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16
Q

How do pituitary tumours present?

A
  • Visual disturbance due to compression of optic chiasm

- Hormone balance

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17
Q

What type of tumours are pituitary tumours?

A
  • Mainly benign

- Only 1% are malignant

18
Q

How can brain tumours present?

A
  • Raised intracranial pressure (mass effect)
  • Focal neurological deficit
  • Epileptic fits
  • CSF obstruction
19
Q

What are the symptoms of raised ICP?

A
  • Headache (typically morning headache)
  • Nausea / vomiting
  • Visual disturbance (diplopia, blurred vision)
  • Somnolence
  • Cognitive impairment
  • Altered consciousness
  • Papilloedema
  • 6th nerve palsy
  • Cognitive impairment
  • Altered consciousness
  • 3rd nerve palsy
20
Q

When can brain tumours result in hydrocephalus?

A
  • Tumours in or close to CSF pathway especially posterior fossa tumours
  • Especially in children
21
Q

How much CSF is produced in hydrocephalus?

A

CSF production 400 - 450 cc / day

22
Q

How are brain tumours diagnosed?

A
  • History and examination
  • Think of sources of secondary tumours (eg CXR)
  • CT scan
  • MRI scan
  • Biopsy
23
Q

What symptoms can occur with focal neurological deficit?

A
  • Hemiparesis
  • Dysphasia
  • Hemianopia
  • Cognitive impairment (memory, sense of direction)
  • Cranial nerve palsy
  • Endocrine disorders
24
Q

What are 2 main classifications of epilepsy?

A
  • Focal epilepsy

- Generalised epilepsy

25
Q

When can epilepsy occur with brain tumours?

A

Only in lesions above tentorium

26
Q

What percentage of 1st fits are due to tumours?

A

First fit - 20% chance of tumour

27
Q

What types of imaging can be used for brain tumours?

A
  • CT
  • MRI
  • PET
  • (Angiography)
28
Q

What investigations should be carried out if you suspect metastatic disease?

A
  • CT chest/abdo/pelvis
  • Mammography
  • Biopsy skin lesions/lymph nodes
29
Q

What are the goals of management of brain tumours?

A
  • Accurate tissue diagnosis
  • Improve quality of life by decreasing mass effect and improving neurological deficit
  • Aid effect of adjuvant therapy
  • Prolong life expectancy
30
Q

What types of treatment can be used to manage brain tumours?

A
  • Corticosteroids (Dexamethasone)
  • Treat epilepsy (anticonvulsant drugs)
  • Analgesics / antiemetics
  • Counselling
  • Surgery
  • Radiotherapy
  • Chemotherapy
  • Endocrine replacement
31
Q

What are the management options for glioblastoma multiforme?

A
  • Complete surgical excision impossible so biopsy or debulk only
  • Steroids
  • Anticonvulsants
  • Radiotherapy
  • Chemotherapy (temazolamide)
32
Q

What are the management options for metastatic disease?

A
  • Must confirm diagnosis
  • Steroids
  • Anticonvulsants
  • Radiotherapy ( whole brain, steriotatic)
  • Surgery
33
Q

What is the prognosis of meningiomas?

A
  • Commonly cured by surgery

- May require antoconvulsants

34
Q

What is the prognosis of low grade astrocytomas?

A

Long life expectancy

35
Q

What is the prognosis of high grade GBM?

A

Average 1 year survival

36
Q

What is the prognosis of metastatic disease?

A

Frequently good medium term remission

37
Q

When should you definitely not perform an LP?

A

When there are signs and/or symptoms to suggest an intracranial mass lesion

38
Q

Why should a LP not be carried out when there is suggestion of an intracranial mass?

A

You might cause a herniation syndrome and the patient could die

39
Q

What is a common primary malignant tumour?

A

Glioma (GBM)

40
Q

What are common primary benign tumours?

A
  • Meningioma

- Pituitary adenoma

Systems: Neurology AB (51 decks)

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