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Neurology > Brain Tumours > Flashcards

Brain Tumours Flashcards

1
Q

What is a brain tumour?

A

A growth of cells

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2
Q

Outline the 4 most common ways that brain tumours present (in order of most to least common).

A

Progressive neurological deficit 68%.
Usually motor weakness 45%.
Headache 54%.
Seizures 26%.

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3
Q

What can raised ICP occur due to?

A

Contribution to mass within a ‘rigid closed box’

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4
Q

Give examples of things that cause raised ICP.

A

tumour mass
oedema
blockage of CSF flow ie. hydrocephalus
haemorrhage

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5
Q

What are the symptoms associated with raised ICP?

A

Headaches.
Vomiting.
Mental changes.
Seizures

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6
Q

When should you think about surgery for a brain tumour?

A

If >5mm tumour

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7
Q

When should you think about conservative management for a brain tumour?

A

If <5mm tumour

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8
Q

Headache can occur WITH/WITHOUT raised ICP

A

BOTH

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9
Q

Describe the features of a headache associated with a brain tumour.

A
  • Worse in the morning; wakes person up.
  • Worse with coughing or leaning forward (30%).
  • Might be associated with, and made a bit better by vomiting.
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10
Q

What may a headache associated with a brain tumour be similar to?

A

Tension headache or migraine

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11
Q

What cranial nerve has a torturous long course in the brain and is thus more likely to be affected by brain tumours?

A

CN VI

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12
Q

Why may someone with a brain tumour have a headache?

A

The tumour may compress on the dura, blood vessels or periosteum and cause pain

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13
Q

What is the investigation of choice in brain tumours?

A

MRI

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14
Q

Who should have an urgent suspicious cancer referral?

A
  • Focal neurological deficit
  • Change in behaviour
  • Seizure
  • Headache, vomiting or papilloedema
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15
Q

What are the 2 most common cell types from which neuroepithelial tumours arise?

A

Astrocytes

Oligodendroglial cells

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16
Q

Outline the WHO grading system for Astrocytic tumours.

A

I: Pilocytic, Pleomorphic xanthoastrocytoma, Subependymal giant cell.

II: Low grade astrocytoma.

III: Anaplastic astrocytoma.

IV: Glioblastoma multiforme

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17
Q

Describe 2 key features of Grade 1 Astrocytomas.

A
  • Truly benign

* Slow growing

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18
Q

Who is most commonly affected by Grade 1 Astrocytomas.

A

Children

Young adults

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19
Q

Where do Pilocytic astrocytomas tend to affect?

A

Optic nerve.
Hypothalamic gliomas.
Cerebellum.
Brainstem

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20
Q

What is the treatment of choice for Pilocytic astrocytomas?

A

Surgery

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21
Q

How do Pilocytic astrocytomas appear on imaging?

A

Well circumscribed, uniformly strongly enhanced lesions

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22
Q

How do children with Grade 1 Astrocytomas present?

A

Tend to begin walking on tiptoes.
Go back on developmental milestones.
Begin vomiting

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23
Q

What are the typical cellular features of ‘low grade, grade II astrocytomas’?

A

Hypercellularity.
Pleomorphism.
Vascular proliferation.
Necrosis.

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24
Q

What areas of the brain do grade II astrocytomas usually appear in?

A

Temporal lobe.
Posterior frontal lobe.
Anterior parietal lobe

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25
Q

How do grade II astrocytomas usually present?

A

SEIZURES

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26
Q

What is the treatment of grade II astrocytomas?

A

Surgery

+ chemo +/- radiotherapy

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27
Q

What is a grade II astrocytoma also known as?

A

Glioblastoma

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28
Q

What is surgery in grade II astrocytomas used for?

A

Seizure control.
Tx of herniation.
Relief of CSF obstruction.
Cytoreduction

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29
Q

What grades of astrocytic tumours are malignant?

A

III - IV

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30
Q

Anaplastic astrocytomas can arise….

A

DE NOVO

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31
Q

What is the most common primary tumour?

A

Glioblastoma multiforme

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32
Q

What is the spread of glioblastoma multiforme like?

A

White matter tracking or CSF pathways

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33
Q

There is no curative treatment for malignant astrocytomas, but what can be done?

A

Surgery to improve survival quality

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34
Q

What does the surgery in malignant astrocytomas involve?

A
  • cytoreduction.

* reducing mass effect

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35
Q

What is radiotherapy used for?

A

Malignant tumours post-op

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36
Q

When is radiotherapy used in low grade astrocytomas?

A
  • Incomplete removal.

- Malignant degeneration (+/- surgery).

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37
Q

When is radiotherapy used in the treatment of benign astrocytomas?

A

Only if recurrence/progression is not amenable to surgery

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38
Q

What are the side effects of radiotherapy?

A

Drops IQ by 10
Skin damage
Hair damage/change/loss
Tiredness

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39
Q

Who is the side effects of radiotherapy not good in?

A

Children - drops IQ by 10

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40
Q

What lobe do oligodendroglial tumours occur in?

A

FRONTAL

41
Q

What are the peak ages of oligodendroglial tumours?

A

Adults of 25-45 years.

Smaller peak in children of 6-12 years

42
Q

What symptoms do people with oligodendroglial tumours present with?

A

SEIZURES

43
Q

Oligodendroglial tumours often have subarachnoid granulations which can be said to look like?

A

Toothpaste

44
Q

Peripherally, what do oligodendroglial tumours have?

A

Calcification

45
Q

What are the 3 features that allow oligodendroglial tumours to be easily distinguished from astrocytomas?

A
  • *Calcification – usually peripheral
    • Cysts
    • Peritumoral haemorrhage
46
Q

What are ‘collision’ tumours?

A

Tumours where oligodendroglial cells co-exist with astrocytic cells in a neoplastic collision type of tumour

47
Q

Are oligodendroglial tumours chen-sensitive?

A

YES

48
Q

What is the gold standard treatment of oligodendroglial tumours?

A

SURGERY + CHEMOTHERAPY

49
Q

Surgery is not great for ‘high grade’ oligodendroglial tumours

A

TRUE

50
Q

What does radiotherapy do for oligodendroglial tumours?

A

Reduces seizures

51
Q

IF SOMEONE WHO PRESENTS WITH HEADACHE THAT WAKES THEM IN THE MORNING + VOMITING

A

ALWAYS CHECK FOR A NEW NEUROLOGICAL DEFICIT

52
Q

What do meningiomas arise from?

A

Arachnoid cap cells

53
Q

Meningiomas are INTRAXIAL

A

FALSE - extraxial

54
Q

The majority of intracranial neoplasms are …………

A

ASYMPTOMATIC

55
Q

Who gets meningiomas more?

A

MEN

56
Q

What other types of cancers are meningiomas associated with?

A
  • Breast
  • Multiple meningiomas
  • Meningioma en plaque
57
Q

Describe meningioma en plaque.

A

A morphological subgroup within the meningiomas, defined by a carpet or sheet-like lesion that infiltrates the dura and sometimes invades the bone.

58
Q

To avoid the recurrence of meningiomas, what should be done?

A

All involved bone should be removed

59
Q

What are the symptoms associated with meningiomas?

A
  • Headaches
  • Cranial nerve neuropathies if affecting skull base
  • Regional anatomical disturbance
60
Q

90% of meningiomas are ……

A

BENIGN

61
Q

Meningiomas are FAST growing

A

FLASE - slow

62
Q

When do meningiomas often grow?

A

These often grow during pregnancy due to elevated oestrogen levels

63
Q

Who (+ where) in particular should you be aware of the possibility of radiation-induced meningiomas?

A

People who have had childhood leukaemia

typically occur in midline

64
Q

What are the important features to be aware of on CT of someone with a meningioma?

A
  • Homogenous, densely enhancing.
  • Oedema.
  • Hyperostosis/Skull ‘blistering.’
65
Q

What are the important features of a meningioma on MRI?

A
  • Dural tail. (+ beaking)

* Patency of dural sinuses

66
Q

What 3 Ix’s should always be done in someone with a suspected meningioma?

A

CT
MRI
Angiography/embolisation

67
Q

Why is angiography/embolisation done in someone with a meningioma?

A

Because meningiomas are usually quite vascular, preoperative embolisation can ease complete tumor resection by diminishing operative time and intraoperative blood loss

68
Q

What is used for embolisation in someone with a meningioma?

A

External carotid artery feeders
OR
Occlusion of sagittal sinus

69
Q

How are small meningiomas managed?

A

‘Watch and wait’

70
Q

When is surgery done for a meningioma?

A

If tumour >3-4cm

71
Q

Give 3 examples of nerve sheath tumours.

A
  • Schwannomas (aka neuromas) - acoustic neuroma is most common
  • Neurofibromas
  • Malignant peripheral nerve sheath tumours (MPST)
72
Q

What is an acoustic neuroma?

A

Vestibular schwannoma of 8th cranial nerve

73
Q

What condition is acoustic neuroma associated with?

A

Neurofibromatosis II

74
Q

List the symptoms associated with vestibular schwannoma.

A
  • Hearing loss
  • tinnitus
  • Dysequilibrium
75
Q

What may vestibular schwannoma lead to? Why?

A

Hydrocephalus – if get really big and press on the 4th ventricle

76
Q

What investigation is needed for someone with acoustic neuroma?

A

Audiometry
+
Radiographic

77
Q

If acoustic neuromas are small they are usually left alone. Why?

A

Due to risk of damage to facial nerve

78
Q

What does medical management of acoustic neuromas usually involve?

A
  1. Periodic neuro exam.
  2. Hearing aid.
  3. Periodic MRI
79
Q

How are 50% of acoustic neuromas managed surgically?

A

‘Hearing preserving surgery’

80
Q

Give 4 (iatrogenic) problems that may arise after surgery for an acoustic neuroma.

A

Facial nerve palsy.
Corneal reflex.
Nystagmus.
Abnormal eye movement

81
Q

What is the peak incidence of pineal tumours?

A

10-12 years old

82
Q

Who is more affected by pineal tumours?

A

MALES

83
Q

How do pineal tumours appear on CT?

A

ISO or HYPER dense

84
Q

What may pineal tumours metastasise via?

A

CSF

85
Q

What is the most common CNS germ cell tumour?

A

Germinomas

86
Q

How are germinomas treated?

A

RADIOTHERAPY

they are very radiosensitive

87
Q

Give examples of germinomas.

A

Teratoma – mature, immature.
Yolk sac tumour.
Choriocarcinoma.
Embryonal carcinoma

88
Q

What are tumour markers highly specific for?

A

Germ cell tumours

89
Q

Name 3 tumour markers.

A 
Alpha Fetoprotein (AFP)
Human Choriogonadotrophin (beta-HCG)
Placental Alkaline Phosphatase (PLAP)
90
Q

What is AFP synthesised by?

A

Yolk sac endoderm and embryonic intestinal epithelium

91
Q

What tumours is AFP present in?

A

Yolk sac tumours (+ teratomas)

92
Q

What is HCG synthesised by?

A

Syncytiotrophoblasts

93
Q

What tumours is HCG present in?

A

Choriocarcinoma (+ germinoma)

94
Q

What is PLAP synthesised by?

A

Primordial germ cells + syncytiotrophoblasts

95
Q

What tumours is PLAP found in?

A

Germinoma (+ choriocarcinoma, yolk sac)

96
Q

What is used to treat hydrocephalus?

A

VP shunt

97
Q

What is the Stupp protocol and what is it used for?

A

Surgery + Radiotherapy + Chemo (TMZ)

Used in treatment of malignant astrocytomas

98
Q

What does Stupp protocol do?

A

Increases mean survival to 14 months

Neurology (42 decks)

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