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RB Y3 1.2 Neurology > Brain Tumours > Flashcards

Brain Tumours Flashcards

1
Q

general presentation of brain tumours

A
  • progressive focal neurological deficit
  • motor weakness
  • raised ICP features (headache)
  • seizures
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2
Q

acute onset of symptoms?

A

tumour can cause eg if starts bleeding

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3
Q

name 4 supratentorial herniations

A
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4
Q

what happens in an uncal herniation

A

the medial part of the temporal lobe (uncus) herniates inferiorly to the tentorium cerebelli

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5
Q

which type of herniation can damage CNIII

A

uncal - ipsilateral fixed blown pupil

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6
Q

describe ICP headache

A
  • awaken them from sleep
  • exacerbated by couging, sneezing,bending
  • worse on lying down
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7
Q

raised ICP features

A
  • vomiting without nausea
  • ocular palsy
  • back pain
  • papilloedema - bilateral
  • alteredlevel of consciousness
  • seizures
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8
Q

cushings triad

A

Cushing’s triad: increase in systolic and pulse pressure, bradycardia and irregular respiration

  • Raised ICP to the point where it exceeds MABP, this causes the arterioles in the brains cerebrum to become compressed. Compression results in cerebral ischaemia
  • Activation of sympathetic and parasympathetic nervous system. At this stage sympathetic is activated more and causes hypertension and tachycardia
  • Baroreceptors in the aortic arch detect this and trigger a parasympathetic response via CNX, induces bradycardia
    • Bradycardia may be caused due to direct mechanical distortion of CNX
  • Increased pressure on the brainstem (control of breathing) results in irregular respiratory pattern
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9
Q

presentation of frontal lobe problem

A
  • contralateral weakness due to deficit in M1
  • personality changes - disinhibition and cognitive slowing
  • urinary incontinence due to disruption of micturition inhibition centre
  • gaze abnormalities - frontal eye field involvement
  • expressive dysphasia/aphasia if Brocas area on left is involved
  • seizures
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10
Q

presentation of temporal lobe problem

A
  • memory deficits
  • receptive aphasia/dysphasia for left sided lesions if Wernickes area involved
  • contralateral superior quadrantopia
  • seizures
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11
Q

presentation of parietal lobe problem

A
  • contralateral weakness and sensory loss due to deficit in S1
  • contralateral inferior quadrantopia
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12
Q

parietal lesion on dominant lobe presentation

A

dyscalculia, dysgraphia, finger agnosia, left right disorientation if dominant lobe affected –> gerstmann syndrome

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13
Q

parietal lesion on non dominant lobe presentation

A

neglect (not aware of one side of the body), dressing and constructional apraxia

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14
Q

occipital lobe lesion presentation

A

contralateral homonymous hemianopia, visual hallucinations (V1)

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15
Q

cerebellum lesions presentation

A
  • ipsilateral ataxia
  • n and v
  • dizzines and vertigo
  • slurred speech
  • intention tremor
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16
Q

what does toe walking in children indicate

A

cerebellar problem

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17
Q

very first investigation

A

fundoscopy to check for papilloedema

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18
Q

imaging

A
  • CT is done first - quickest and widely available
  • MRI gives better tissue definition and can be used to grade tumours
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19
Q

what imaging is good for bleeds

A

CT for acute bleed, MRI for chronic/old bleeds

bleed on left, infarct on right

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20
Q

imaging in children

A

avoid CTs as they do a lot of harm, MRI is preferred

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21
Q

what should be suspected when an older person presents with possible brain tumour

A

metastases - always take a cancer history! (haemoptysis, melaena, change in bowel habits, PR bleeding)

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22
Q

what are the characterstics of grade I tumours and who do they occur in

A
  • slow growing, benign
  • children and YP
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23
Q

pilocytic (low grade I tumours) - who gets them

A

children and young adults

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24
Q

pilocytic astrocytoma - pathology

A

bipolar cells with long hair like projections

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25
Q

management of pilocytic astrocytomas

A

surgery, high curative rate. have sharply defined edges so are easily removed

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26
Q

where do pilocytic astrocytomas usually arise

A

cerebellum, brainstem or midline structures, eg thalamus and optic chiasm

27
Q

which condition are pilocytic astrocytomas in the optic chiasm seen in

A

NF1

28
Q

low grade type II tumours prognosis

A
  • are less histologically stable and have the potential to transform to high grade gliomas
29
Q

what symptom do type II tumours often present with

A

seizures

30
Q

common presentation of oligodendrogliomas

A

seizures and headaches

31
Q

common age of presentation fo oligodendrogliomas

A

25-45

32
Q

what appearance does a oligodendrogliomas often have after invading teh subarachnoid space

A

toothpaste appearance

33
Q

prognosis of oligodendrogliomas

A

best

34
Q

where do oligodendrogliomas tend to arise

A

frontal lobe of cerebral hemispheres and can affect white matter and cortex

35
Q

where do diffuse astrocytomas tend to arise

A

frontal and temporal lobes

36
Q

common presentation of diffuse astrocytomas

A

seizures

37
Q

which age group gets diffuse astrocytomas

A

young adults

38
Q

managment of grade II tumours

A

surgery and radio and chemo

diffuse astrocytomas are harder to remove as they do not have well defined edges

39
Q

do grade III tumours arise de novo or do they progress from grade I and II

A

either

40
Q

what is the median survival of grade III tumour

A

2 years

41
Q

what is the median survival of grade IV tumour

A

<1 year

42
Q

what is the most common type of grade IV tumour

A

glioblastoma

43
Q

what age group gets GBM

A

older people

44
Q

MRI appearance of GBM

A

butterfly appearance

45
Q

further tests of GBM after MRI

A
  • histological sample
  • tissue molecular analysis to predict response to alklyating agent chemotherapy (temozolamide)
46
Q

can you cure grade III and IV tumours

A

no, can improve survival

47
Q

management of grade III adn IV tumours

A

chemo radio and surgery -Stupp protocol - improves median survival

48
Q

what agent is used for chemo

A

temozolomide - alkylating agent

49
Q

meningiomas

A
  • usually benign tumours that arise from residual mesenchymal cells in the meninges (arachnoidal cap cells in arachnoid membrane)
  • rarely malignant, grow slowly
50
Q

presentation of meningioma

A
  • most are asynmptomatic
  • symptoms of raised ICP
51
Q

what age group gets meningiomas

A

elderly females (6 and 7 decade)

52
Q

what condition is assoicated with multiple meningiomas

A

NF2 (also bilateral acoustic neuroma)

53
Q

Foster Kennedy syndrome

A

can be caused by meningioma in olfactory groove

optic atrophy in the ipsilateral eye (direct pressure on eye) and papilloedema in the contralateral eye (raised ICP)

54
Q

where do acoustic neuromas most ocmmonly arise from

A

cerebellopontine angle

55
Q

where do acoustic neuromas arise from

A

schwann cells, vestibular portion of CNVIII

56
Q

how do acoustic neuromas present

A
  • Progressive ipsilateral tinnitus ± unilateral sensorineural deafness (cochlear nerve compression) ± vertigo
  • Loss of corneal reflex
  • Headache
  • Suspect in any patient with unilateral hearing loss
  • cause raised ICP when bigger
57
Q

pathology of acoustic neuromas

A

Verocay bodies

58
Q

preferred imaging of meningioma

A

MRI

59
Q

which other CN can acoustic neuromas affect

A

CNVII - facial numbness and tingling

60
Q

wht should be suspected if patient is young and has bilateral acoustic neuromas

A

NF2 (multiple meningiomas too)

61
Q

haemangioblastomas

A

benign, cystic, highly vascular tumours

62
Q

where do haemangioblastomas develop

A

posterior fossa - cerebllar dysfunction and raised ICP

63
Q

which syndrome are haemangioblastomas associated with

A

VHL

RB Y3 1.2 Neurology (23 decks)

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