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Neuro > Brain Tumours > Flashcards

Brain Tumours Flashcards

1
Q

What can CNS tumours be

A

Primary

Secondary mets = more common than primary

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2
Q

What are other areas where brain tumours develop

A

Cells outside brain
Cranial nerve
Peripheral nerve

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3
Q

Where do childhood cancers tend to occur

A

Above tentorium

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4
Q

Where do adult brain tumours tend to occur

A

Below tentorium

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5
Q

What is most common brain tumour

A

Glioma’s

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6
Q

What are glioma’s

A

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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7
Q

What is an oligodendroglioma

A

Arise from myelin sheath of cells in brain

Schwann cells = support cells of myelin sheath in PNS

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8
Q

Where does it typically affect and causing what

A

Frontal lobe
Seizures
Headache
Neurological

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9
Q

How do you differentiate from astrocytoma

A

Fried egg appearance

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10
Q

Where do ependymoma arise from

A

Lining of ventricle

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11
Q

What are features of epndymoma

A

Benign but can obstruct

Affect brain in children and spinal cord in adult

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12
Q

What is medullablastoma

A

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

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13
Q

What are tumours from outside CNS

A 
Meningioma - arachnoid cells that cover meninges 
- Stay local 
Schwannoma - nerve sheath cell
Pituitary adenoma 
Lymphoma 
Haemangioblastoma
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14
Q

What are astrocytoma’s

A

Low grade
Grow slowly
Commonly frontal region

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15
Q

How do they present and how do they treat

A

Seizure
Headache
Slow near decline

Rx
Aggressive as can have good prognosis
Do a wake procedure

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16
Q

What are glioblastoma’s

A 
High grade
Common middle age adult 
Atypical tumour with necrosis
Grows quickly 
Butterfly lesion
Frontal / temporal / basal ganglia
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17
Q

How do they present and how do you Rx

A

Seiure
Headache
Slow neuro decline
Area of necrosis on CT

Rx

  • 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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18
Q

What is a CNS lymphoma

A 
High grade
Usually B cell
Common in immunocompromised e.g. HIV 
Often deep and difficult to biopsy 
Do not metastasise
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19
Q

What are mengioma

A 
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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20
Q

What are mengioma associated with

A

NF-2

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21
Q

How do they present

A

Asymptomatic
Focal or generalised seizure
Gradual worsening neurological function

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22
Q

On CT

A

Area of calcification

Smooth lobulated mass

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23
Q

What does pituitary adenoma cause in children

A

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

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24
Q

What does pituitary adenoma cause in adults

A 
Increased fat
Decreased muscle mass
Decreased bone density
Bitemporal hemianopia - UQ defect 
CSF obstruction 
Seizure
Raised ICP
25
Q

What is a vestibular schwanoma

A

Tumour of Schwann cells that surround vestibular nerve

26
Q

When are bilateral seen

A

NF2

27
Q

What do they cause

A 
Depends what CN affected 
Vertigo
Hearing loss - unilateral sensorineural = common
Tinnitus
Absent corneal if trigeminal affected
Facial palsy if facial affected
28
Q

How do you Dx

A

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

29
Q

How do you Rx

A

Surgery
RT
Can just observe as often slow growing

30
Q

What are common presentations of brain tumour

A 
Neurological deficit
Headache
Seizures 
Signs of raised ICP 
Hydrocephalus
Papilloedema
31
Q

How do cerebral tumours present

A 
Headache
Vomiting
Visual field
Hemiparesis
Hypokinesia
Seizure
Change in personality
32
Q

How do brain stem tumours present

A 
Hearing loss
Facial pain and weakness 
Dysphagia
Decreased gag reflex
Nystagmus
Failure up gaze
33
Q

How do cerebellar tumours present

A

Ataxia
Dysarthria
Coordination
DANISH P

34
Q

How do pituitary tumours present

A

Endocrine dysfunction
Visual defect - bitemporal hemianopia - UQ
Headache

35
Q

Frontal lobe

A 
Headache
Motor dysfunction
Broca's dysphasia
Executive dysfunction 
Inappropriate behaviour
Personality change
Poor concentration 
Memory loss 
Unilateral anmosia
36
Q

Parietal Lobe

A 
Hemisensory loss / paresthesia
Loss 2 point discrimination
Agnosia
Sensory inattneiton
Dysphasia
37
Q

Temporal Lobe

A 
Seizures
Behaviour change
Hallucination
Visceral Sx
Superior homonymous hemianopia
Dysphasia
LOC
38
Q

Occipital lobe

A

Visual disturbance

Contralateral visual field defect

39
Q

How do you Dx

A 
History 
CT with contrast = 90%
MRI 
MRA
PET
LP
Biopsy
40
Q

What is mainstay treatment

A

Surgical
RT
Chemo to slow cell growth

41
Q

Surgical options

A

Resection
Craniotomy
Transphenoidal
Endoscopic

42
Q

RT options

A

External beam

Intersitital brachytherapy

43
Q

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

A

Corticosteorids - dexamethasone

44
Q

What are complications of chemo

A 
Oral mucositis
Bone marrow suppression
Fatigue
Hair loss 
N+V
Peripheral neuropathy
45
Q

What are complications post op

A 
Increased ICP
Haematoma
Hypovolaemia
Hydrocephalus
Menignitia 
Pulmonary oedeema
Wound infection
Seizure 
CSF leak
46
Q

What is tumour grade vs stage

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

Stage = spread

47
Q

If brain tumour is discovered what should you do

A

Always look for a primary

48
Q

How does craniopharyngioma present

A

LQ bitemporal hemianopia
Hormonal disturbance
Symptoms of hydrocephalus

49
Q

How do you Dx craniopharyngioma / pituitary adenoma

A

Full blood profile and MRI

50
Q

Why do brain tumours not met

A

BBB

51
Q

How do brain tumour cause headache

A

Raised ICP
Vascular
Meningism

52
Q

Why is dexamethasone useful

A

Vasogenic oedema e..g due to disrupted BBB

53
Q

What causes

A

High grade glioma

Mets

54
Q

What kills with brain tumour

A

Cerebral oedema and raised ICP

55
Q

Where are brain mets common

A 
Lung =. 50%
Breast
Colon
Prostate
Kidney 
Melanoma

Histology = same as primary if biopsy

56
Q

How do you investigate

A

MRI with contrast

57
Q

What will MRI show

A 
Multiple discrete well demarcated lesion 
Hypointense on T1
Hyperintense on T2
Marked gadolinium enhancement 
Considerable vaosgenic oedema
58
Q

How do you manage

A

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

59
Q

What tends to be ring enhancing lesion

A

TB

Absess

Neuro (19 decks)

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