Brain Tumours Flashcards
What headache red flags should make you suspicious about brain tumours?
Worse in the morning
Wakes them up
Worse with coughing and on leaning forward
Associated with vomiting
What is the most common type of brain tumour?
Metastases
What is the most common type of primary brain tumours in adults?
Astrocytoma (high grade gliomas)
What type of brain tumour has a “butterfly” appearance on MRI?
Glioblastoma Multiforme
high grade glioma/ astrocytoma
Anaplastic astrocytoma and glioblastoma multiforme are both types of high grade glioma. Which has the worst prognosis?
Glioblastoma multiforme (median survival is <1 year)
Give some examples of neuroepithelial tumours
Atrocytomas
Oligodendrogial tumours
Give some examples of extra-axial tumours
Meningiomas
Pituitary tumours
Acoustic neuromas
Which type of tumour causes a “white toothpaste” appearance when they invade the subarachnoid space?
Oligodendrogial tumours
Why is survival higher with oligodendroglial tumours than other gliomas?
They are very chemosensitive
What are meningiomas?
Benign tumours of mesenchymal cells
There is an increased risk of multiple meningioma in patients with which conditions?
Neurofibromatosis type 2 or PMH of radiation
What are ‘meningioma en plaque’?
A subgroup of meningiomas which involve a carpet/ sheet-like lesion that infiltrates the dura and sometimes invades the bone
What kind of symptoms do meningiomas cause?
Mostly asymptomatic
May present with headaches and symptoms of raised ICP by compressing the underlying brain
Which type of brain tumour originates from arachnoid cap cells in the arachnoid membrane?
Meningiomas
Where do oligodendroglial tumours arise?
In the frontal lobes
Does the brain have pain sensation?
No, but the skin and dura e.t.c surrounding the brain do
What is Foster-Kennedy syndrome?
Optic atrophy in the ipsilateral eye and papilloedema in the contralateral eye
Caused by a meningioma in the olfactory groove
/ or another type of brain tumour occurring in the frontal lobe of the brain
What are the size limits for a microadenoma Vs a macroadenoma?
microadenomas < 10mm, macroadenomas >10mm
Give some examples of conditions caused by functional pituitary tumours
Acromegaly and Cushing’s disease
*Functional pituitary tumours secrete pituitary hormones
How are most pituitary tumours managed?
Transphenoidal hypophysectomy surgery
How might a prolactinoma (type of pituitary tumour) present?
Amenorrhoea
Infertility
Loss of libido
Gelactorrhoea
Erectile dysfunction
What investigation can be done for a prolactinoma and how is it managed?
Prolactin levels and imaging
Dopamine agonists e.g cabergoline
What condition would a GH secreting tumour cause?
Acromegaly
Growth of hands and feet
Carpal tunnel
Diabetes
e.t.c
How would acromegaly be investigated and managed?
GH levels after glucose tolerance test
Managed with pegvisomant and somatostatin analogues
What condition would an ACTH secreting tumour cause?
Cushing’s
Central obesity Hirsutism Acne Hypertension Moon face e.t.c
How would an ACTH secreting tumour be investigated?
Dexamethasone suppression test
How would a thyrotropinoma (type of pituitary tumour) present?
Palpitations Weight loss Insomnia Anxiety Goiter e.t.c (symptoms of hyperthyroidism)
How would a thyrotropinoma be investigated?
TSH, T3 and T4
would all be elevated
What tumour is extra-axial and derived from schwann cells?
Acoustic neuroma (aka vestibular schwannoma)
Most acoustic neuromas are unilateral, which condition should be considered if the tumour is bilateral?
Neurofibromatosis type 2
Verocay bodies can be seen pathologically with which type of tumour?
Acoustic neuroma
How might an acoustic neuroma present?
Unilateral sensorineural hearing loss
Tinnitus
Vertigo
Facial pain/ numbness (if trigeminal nerve is involved)
What are the risks of operating on an acoustic neuroma?
Facial nerve palsy
Nystagmus
Hemangioblastomas are benign, highly vascular tumours. Where are they most commonly found?
Posterior fossa
Multiple asymptomatic hemangioblastomas are associated with which condition?
Von Hippel-Landau syndrome
What 3 bloods should be done to investigate any midline brain tumour in children
ABP, HCG and LDH
suspect pineal tumour
Which form of imaging is best to do in children?
MRI
CT has a high dose of radiation
What is the risk of post op radiotherapy in children?
Can lower IQ
What is the most common primary brain tumour in children?
Medullobastoma
How can oligodendrogial tumours be differentiated from astrocytomas?
By the presence of calcification, cysts and peritumoral haemorrhage
What clinical signs in children are suggestive of a brain tumour?
Tiptoeing and ataxia
