Form from glial cells - brain supporting cells - Oligodendroglioma if oligodendrocyte - Astrocytoma if from astrocytes = most common - Ependyoma if from ependymal cells - Glioblastoma multiform if high grade Malignant but don't metastases outside CNS Spread through white matter and CSF - Can't resect as spread through whole brain by time of presentation Graded 1-4

Brain Tumours Flashcards by Eilidh Seaton

What can CNS tumours be

Primary

Secondary mets = more common than primary

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What are other areas where brain tumours develop

Cells outside brain
Cranial nerve
Peripheral nerve

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Where do childhood cancers tend to occur

Above tentorium

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Where do adult brain tumours tend to occur

Below tentorium

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What is most common brain tumour

Glioma’s

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What are glioma’s

Form from glial cells - brain supporting cells

Oligodendroglioma if oligodendrocyte
Astrocytoma if from astrocytes = most common
Ependyoma if from ependymal cells
Glioblastoma multiform if high grade

Malignant but don’t metastases outside CNS
Spread through white matter and CSF
- Can’t resect as spread through whole brain by time of presentation

Graded 1-4

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What is an oligodendroglioma

Arise from myelin sheath of cells in brain

Schwann cells = support cells of myelin sheath in PNS

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Where does it typically affect and causing what

Frontal lobe
Seizures
Headache
Neurological

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How do you differentiate from astrocytoma

Fried egg appearance

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Where do ependymoma arise from

Lining of ventricle

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What are features of epndymoma

Benign but can obstruct

Affect brain in children and spinal cord in adult

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What is medullablastoma

Malignant tumour from embryonic neural cells
Often childhood
Affects posterior and brain stem
Difficult for surgery Mx

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What are tumours from outside CNS

Meningioma - arachnoid cells that cover meninges 
- Stay local 
Schwannoma - nerve sheath cell
Pituitary adenoma 
Lymphoma 
Haemangioblastoma

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What are astrocytoma’s

Low grade
Grow slowly
Commonly frontal region

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How do they present and how do they treat

Seizure
Headache
Slow near decline

Rx
Aggressive as can have good prognosis
Do a wake procedure

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What are glioblastoma’s

High grade
Common middle age adult 
Atypical tumour with necrosis
Grows quickly 
Butterfly lesion
Frontal / temporal / basal ganglia

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How do they present and how do you Rx

Seiure
Headache
Slow neuro decline
Area of necrosis on CT

Surgical to debulk but won’t clear
Surgery will give Dx of underlying cell and grade
Require post op chemo + RT
Dexamethasone for oedema
Rx is never curative

Prognosis

15 months with Rx
Weeks- months without

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What is a CNS lymphoma

High grade
Usually B cell
Common in immunocompromised e.g. HIV 
Often deep and difficult to biopsy 
Do not metastasise

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What are mengioma

Benign cancer from arachnocytes
Attached to dura 
Do not metastasie
Can be locally invasive causing raised ICP 
Slow growing
Often resectable but can be challenging if in difficult area
- Posterior fossa
- Cavernous sinus
- Skull base

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What are mengioma associated with

NF-2

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How do they present

Asymptomatic
Focal or generalised seizure
Gradual worsening neurological function

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On CT

Area of calcification

Smooth lobulated mass

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What does pituitary adenoma cause in children

Hormone deficiency or surplus
Dwarfism
Slow growth
Absent sexual development / puberty

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What does pituitary adenoma cause in adults

Increased fat
Decreased muscle mass
Decreased bone density
Bitemporal hemianopia - UQ defect 
CSF obstruction 
Seizure
Raised ICP

What is a vestibular schwanoma

Tumour of Schwann cells that surround vestibular nerve

When are bilateral seen

NF2

What do they cause

``` Depends what CN affected Vertigo Hearing loss - unilateral sensorineural = common Tinnitus Absent corneal if trigeminal affected Facial palsy if facial affected ```

How do you Dx

Refer ENT Audiogram MRI of cerebropontine angle as where they commonly occur

How do you Rx

Surgery RT Can just observe as often slow growing

What are common presentations of brain tumour

``` Neurological deficit Headache Seizures Signs of raised ICP Hydrocephalus Papilloedema ```

How do cerebral tumours present

``` Headache Vomiting Visual field Hemiparesis Hypokinesia Seizure Change in personality ```

How do brain stem tumours present

``` Hearing loss Facial pain and weakness Dysphagia Decreased gag reflex Nystagmus Failure up gaze ```

How do cerebellar tumours present

Ataxia Dysarthria Coordination DANISH P

How do pituitary tumours present

Endocrine dysfunction Visual defect - bitemporal hemianopia - UQ Headache

Frontal lobe

``` Headache Motor dysfunction Broca's dysphasia Executive dysfunction Inappropriate behaviour Personality change Poor concentration Memory loss Unilateral anmosia ```

Parietal Lobe

``` Hemisensory loss / paresthesia Loss 2 point discrimination Agnosia Sensory inattneiton Dysphasia ```

Temporal Lobe

``` Seizures Behaviour change Hallucination Visceral Sx Superior homonymous hemianopia Dysphasia LOC ```

Occipital lobe

Visual disturbance | Contralateral visual field defect

How do you Dx

``` History CT with contrast = 90% MRI MRA PET LP Biopsy ```

What is mainstay treatment

Surgical RT Chemo to slow cell growth

Surgical options

Resection Craniotomy Transphenoidal Endoscopic

RT options

External beam | Intersitital brachytherapy

What do you give to control oedema caused by RT / surgery

Corticosteorids - dexamethasone

What are complications of chemo

``` Oral mucositis Bone marrow suppression Fatigue Hair loss N+V Peripheral neuropathy ```

What are complications post op

``` Increased ICP Haematoma Hypovolaemia Hydrocephalus Menignitia Pulmonary oedeema Wound infection Seizure CSF leak ```

What is tumour grade vs stage

``` GX = not assessed G1 = low grade, well differentiaed G2 = moderate differentiation G3 = poorly differentiated, high grade G4 = high grade ``` Stage = spread

If brain tumour is discovered what should you do

Always look for a primary

How does craniopharyngioma present

LQ bitemporal hemianopia Hormonal disturbance Symptoms of hydrocephalus

How do you Dx craniopharyngioma / pituitary adenoma

Full blood profile and MRI

Why do brain tumours not met

BBB

How do brain tumour cause headache

Raised ICP Vascular Meningism

Why is dexamethasone useful

Vasogenic oedema e..g due to disrupted BBB

What causes

High grade glioma | Mets

What kills with brain tumour

Cerebral oedema and raised ICP

Where are brain mets common

``` Lung =. 50% Breast Colon Prostate Kidney Melanoma ``` Histology = same as primary if biopsy

How do you investigate

MRI with contrast

What will MRI show

``` Multiple discrete well demarcated lesion Hypointense on T1 Hyperintense on T2 Marked gadolinium enhancement Considerable vaosgenic oedema ```

How do you manage

High dose dexamethasone with PPI cover Symptom control e.g. seizure Liase with oncology to Dx primary Whole brain RT Consider chemo if chemo-sensitive tumour - SCLC / breast Consider neurosurgery - biopsy useful if unknown primary

What tends to be ring enhancing lesion

TB | Absess