Brain Tumours Flashcards
What classification of brain tumour is a glioma?
A tumour do neuroepithelial tissue
What classification of brain tumour is a meningioma?
Tumour of meninges
What is the common type of pituitary tumour?
Adenoma
What are the most common causes of secondary metastasis to the brain?
Renal cell carcinoma Lung cxarcinoma Breast carcinoma Malignant melanoma GI tract
What type of cells are gliomas derived from?
Astrocytes
What grade is gliomas?
Grade IV
Where are glioblastomas most commonly found?
In the anterior and middle fossae
Not normally found int he posterior cranial fossa
What type of brain tumours are slow growing and fast growing?
Slow growing = meningiomas
Fast growing = gliomas
Are meningiomas benign or malignant?
Benign
From what meninges does a meningioma derive form?
Arachnoid matter
Where does meningiomas common arise ?
Along the falx, sphenoid bone , convexity (surface)
What is the presentation of a pituitary tumour?
Visual disturbance
Hormone imbalance
What investigations would you carry out if you suspected a brain tumour?
CT/MRI head
CXR
Biopsy
What is the clinical presentation of a brain tumour?
Focal neurological deficits
Raised ICP
Epileptic fits
CSF obstruction
What are the signs and symptoms of raised ICP?
Headache - particularly morning Nausea and vomiting Visual disturbances (diplopia, blurred vision) Somnolence Altered conciousness Pappiloedema Cranial nerve palsies (CN III & VI)
How do you identify pappiloedema on fundoscopy?
Non defined optic disc margins
Haemorrhages
What are the signs of Grestmanns syndrome and what causes this?
Acalculia
Agraphia
Finger agnosia
Right/left confusion
Occurs with parietal lesion
Epilepsy is a symptom of brain tumours that only lie where?
Above the tentorium - in the cerebral hemisphere
What is the treatment for glioblastoma?
Debulk tumour (complete excision is impossible)
Steroids, anti convulsants
Radiotherapy, chemotherapy
What is the best chemotherapy drug for treating glioblastoma?
Temazolamide
What is the prognosis for a high grade astrocytoma (glioblastoma)?
Average 1 year survival
What is the prognosis for a meningioma?
Commonly cured by surgery, may require anticonvulsants
Is a glioblastoma a high or low grade astrocytoma?
High grade astrocytoma
Why do you not perform a LP if a patient has suspected intracranial mass lesion?
A mass lesion = raised intracranial pressure
Performing a LP will therefore cause herniation syndrome (coning)
what is the cause of a generalised pathology causing raised intracranial pressure? (not a SOL)
oedema post trauma
if there is raised ICP and it causes a part of the right cerebral hemisphere to be pushed over to the left, what type of herniation is this?
subfalcine herniation (midline shift)
if there is herniation of the cerebrum moving inferiorly under the tentorium, what is this called?
unal herniation
if there is herniation of the brain through a skull fracture what is this called?
transcalvarial herniation
due to raised ICP, what sign would you see if the brain was squeezing on the optic nerve?
papilloedema
due to raised ICP, what sign would you see if the brain was squeezing on the cortex and brainstem?
morning headaches and nausea
falling glasgow coma scale
what can also cause morning headaches (not including raised ICP)?
hypoglycaemia through he night
if there is squeeze on the CN III due to raised ICP, what sign would you see?
pupillary dilatation
name a type of brain tumour derived from brain cells?
gliomas - glioblastoma, astrocytoma, ependymoma
name a brain tumour derived from arachnoid cells.
meningioma
are medulloblastomas benign or malignant?
malignant
in what age group would you find meduloblastomas?
children
what is the distribution of brain tumours with adults compared to children?
brain tumours more commonly occur above the tentorium in adults and below in children
what is the general appearance of gliomas?
diffuse edges
not encapsulated
are gliomas benign of malignant?
malignant but don’t spread outside the CNS
what is the pathology of astrocytomas?
bland cells on microscopy similar to normal astrocytes
grow very slowly
what is the pathology of glioblastoma?
cellular, atypical tumour with necrosis
grow quickly
large cell with multiple nuclei and irregular nucleus
from what cells are medulloblastomas derived from and what is the pathology like?
neuroectodermal cells
(primitive neural cells)
sheets of small undifferentiated cells
what is the pathology of meningiomas?
benign but can be locally aggressive
slow growing
bland cells forming small groups
sometimes calcification
name an example of a shwannoma and describe its pathology.
vestibulocochlear nerve schwannoma - acoustic neuroma
occurs at angle between pons and cerebellum
causes unilateral deafness
benign
describe the pathology of CNS lymphoma.
high grade neoplasm
usually diffuse Bcell lymphoma
often deep and central site in the brain
why is CNS lymphoma difficult to treat?
often deep and central site within brain so difficult to biopsy
drugs don’t cross BBB
name a brain tumour of blood vessels and where it commonly occurs.
haemangioblastoma
most often in cerebellum
