Brain Tumours Flashcards
Name the two classification of brain tumours and what is the difference?
Primary (arise from brain tissue) and secondary (metastases from other areas)
Name three different types of primary brain tumours
- Glioma - neuroepithelial tissue
- Meningioma - meninges
- Adenoma - pituitary
Name the commonest tumours that spread to the brain
- Renal cell carcinoma
- Lung carcinoma
- Breast carcinoma
- Malignant melanoma
- GI tract
Name is a difference between primary and secondary brain tumours which will be apparent on a scan?
Primary will usually be singluar and secondary is multiple
What do gliomas arise from?
Gliomas are derived from astrocytes (structural and nutritional support to nerve cells)
What are the features of gliomas?
WHO grade I-IV
Grade IV:
• Most common
• Most aggressive
• Glioblastoma multiforme (GBM)
• Spread by tracking through white mater and CSF pathway
• Very rarely spread systemically (to body)
What are the characteristics of meningiomas?
- Slow growing
- Extra-axial
- Usually benign
- Arise from arachnoid
- Frequently occur along falx, convexity, or sphenoid bone
- Usually cured if completely removed
What is the most common pituitary tumour?
Adenoma
What is the presentation of a pituitary tumour?
- Visual disturbance due to compression of optic chiasma (bitemporal hemianopia)
- Hormone imbalance
What is the clinical presentation of brain tumours?
- Raised intracranial pressure
- Focal neurological deficiT
- Epileptic fits
- CSF obstruction
What are the symptoms of raised ICP?
- Headache (typically morning headache)
- Nausea / vomiting
- Visual disturbance (diplopia, blurred vision)
- Somnolence
- Cognitive impairment
- Altered consciousness
What are the signs of ICP?
- Papilloedema
- 6th nerve palsy
- Cognitive impairment
- Altered consciousness
- 3rd nerve palsy
What kind of brain tumours cause hydrocephalous?
- Tumours in or close to CSF pathways
- Especially posterior fossa tumours
- Especially in children
What are the signs of focal neurological deficit?
- Hemiparesis
- Dysphagia
- Hemianopia
- Cognitive impairment (memory, sense of direction)
- Cranial nerve palsy
- Endocrine disorders
A 66 year old, left handed, woman presents with ataxia and
in-coordination.
Where would you suspect
her lesion to be?
- Left frontal lobe
- Right frontal lobe
- Brain stem
- Cerebellum
Cerebellum
A 44 year old, right handed, woman presents with acalculia, agraphia,
finger agnosia and right/left confusion.
Where would you suspect her lesion to be?
- Left parietal lobe
- Right parietal lobe
- Left occipital lobe
- Cerebellum
- Left parietal lobe
Gerstmann’s syndrome occurs with left (dominant) parietal lobe lesions
A 30 year old, right handed, man presents with a bitemporal hemianopia. Where would you suspect
his lesion to be?
- Right frontal lobe
- Pituitary
- Left optic nerve
- Right occipital lobe
- Pituitary
Compression of optic chiasma
Presented to medical team with cognitive language dysfunction:
- Difficulty reading emails
- Difficulty expressing what he wished to say
- Short-term memory impairment
Where is the lesion?
- Left temporo-parietal area
- Right fronto-temporal area
- Left occipital lobe
- Right parietal lobe
- Left temporo-parietal area
What are the two classifications of epilepsy?
Focal and generalised
What are the features of epilepsy?
- Only in lesions above tentorium (cerebrum)
- First fit - 20% chance of tumour
- Draws attention to possibility of tumour
- Indicates location of tumour
What investigations are carried out if you suspect metastases?
- CT chest/abdo/pelvis
- Mammography
- Biopsy skin lesions/lymph nodes
What are the management goals?
• Accurate tissue diagnosis • Improve quality of life - Decreasing mass effect/ - Improve neurological deficit • Aid effect of adjuvant therapy (if required) • Prolong life expectancy
Name non-specific management options
- Corticosteroids (dexamethasone)
- Treat epilepsy (anticonvulsant drugs)
- Analgesics / antiemetics
- Counselling
- Surgery
- Radiotherapy
- Chemotherapy
- Endocrine replacement
What can be used to manage Glioblastoma multiforme?
- Complete surgical excision impossible - biopsy or debulk only
- Medical - steroids, anticonvulsants
- Radiotherapy
- Chemotherapy - temazolamide
What is the prognosis of a meningioma?
Commonly cured by surgery - may require anticonvulsants
What is the prognosis of astrocytomas?
- Low grade - long life expectancy
* High grade/GBM - average 1yr survival
When do you not carry out a lumbar puncture?
When there are signs and symptoms to suggest an intracranial mass lesion
4th October presented to ED with decreased level of consciousness
• 1/12 of “slowing down”
• Making uncharacteristic mistakes at work
• 4 day history of drowsiness
• Headache and nauseated
- GSC 11 e3v3m5
- Pupils equal and reactive to light
- No apparent focal neurological signs
- Mild pyrexia (37.5°C)
- Examination of chest/abdomen/breast normal
- No palpable lymphadenopathy or skin lesions
What investigation do you do next?
- Lumbar puncture (LP)
- CT/MRI brain
- CXR
- Full blood count
- CT/MRI brain
Do not carry out LP if symptoms suggest intracranial mass lesion
Why are possible consequences of a lumbar puncture in someone who has a suspected intracranial lesion?
- You might cause meningitis
- You might cause a herniation syndrome and the patient could die
- You might cause an air embolism
- You might make the patient’s headache worse
