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Year 2 - Nervous > Brain tumours > Flashcards

Brain tumours Flashcards

1
Q

Right handed, woman presents with acalculia, agraphia,
finger agnosia and right/left confusion.
Where would you suspect her lesion to be?

A

Left parietal lobe

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2
Q

Left handed, woman presents with ataxia and in-coordination.
Where would you suspect her lesion to be?

A

Cerebellum

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3
Q

Right handed, man presents with a bi temporal hemianopia.

Where would you suspect his lesion to be?

A

Pituitary gland

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4
Q

Right handed man presented to medical team with cognitive language dysfunction:
difficulty reading e mails
difficulty expressing what he wished to say
short-term memory impairment

Also a 6 week history of posterior rib pain

PMHx included a left nephrectomy for renal cell carcinoma

Where is his suspected lesion

A

Left temper-parietal area

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5
Q

Which cranial fossa are GBMs not common in

A

Posterior

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6
Q

Woman presented to A&E with decreased level of consciousness

  • “slowing down”
  • making uncharacteristic mistakes at work
  • 4 day history of drowsiness
  • headache and nauseated

GCS 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 next?

A

CT/MRI brain

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7
Q

If symptoms/signs suggest intracranial lesion, DO NOT do what investigation + why

A

Lumbar puncture because you might cause herniation of cerebellum –> death

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8
Q

Brain tumours classified into what 2 tumour types

A

Primary

Secondary

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9
Q

Name 3 primary brain tumours

A

Gliomas, e.g. glioblastoma multiforme (GBM) - malignant
Meningioma - usually benign
Pituitary tumour - usually benign

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10
Q

What are secondary brain tumours

A

Metastases

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11
Q

Brain metastases are commonly from what 5 places

A 
Kidney
Lung
Breast
Melanoma (i.e. skin)
Colon
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12
Q

Gliomas (e.g. glioblastoma multiforme, oligodendroglioma) are derived from what cells

A

Glial cells - e.g. astrocytes, oligodendrocytes

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13
Q

Function of astrocytes

A

Provide structural and nutritional support to neurons

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14
Q

Meningiomas arise from which layer of the meninges usually

A

Arachnoid mater

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15
Q

Pituitary tumours are most of the time what type of tumour

A

Adenoma

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16
Q

How do brain tumours affect ICP

A

Raise ICP

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17
Q

Focal neurological deficits that brain tumours may present with (5)

A 
Motor weakness - hemiparesis etc
Dysphasia
Visual impairment - hemianopi, diplopia etc
Memory impairment
Cranial nerve palsy
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18
Q

An early warning sign of a tumour could be…

A

Seizures

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19
Q

Symptoms of raised ICP (5)

A 
Headache - usually morning 
Nausea
Vomiting
Visual disturbance - blurry vision etc
Sleepiness
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20
Q

Signs of raised ICP (5)

A 
Papilloedema - pressure on CN II
CN III palsy --> pupillary dilation
CN VI palsy --> convergent squint --> diplopia
Cognitive decline
Altered consciousness
Hydrocephalus
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21
Q

Signs of pituitary tumours (2)

A

Visual disturbance - bitemporal hemianopia (due to compression of optic chasm)
Hormone imbalance

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22
Q

Investigations of brain tumours (3)

If metastases suspected, what other investigations (5)

A

CT head
MRI head
PET

CXR
CT chest/abdo/pelvis
Biopsy of skin lesions/lymph nodes

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23
Q

Treatment of glioblastoma multiforme (5)

A 
Surgical debulking of tumour
\+
Radiotherapy
\+
Chemotherapy - temozolomide

Steroids - dexamethasone
Anticonvulsants - if have seizures

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24
Q

Treatment of meningiomas

  • if asymptomatic
  • if symptomatic (2)
  • if surgery unsuitable (2)
A

If asymptomatic - observe

If symptomatic - surgical resection + radiotherapy

If surgery not suitable - radiotherapy/stereotactic radiosurgery (not actually surgery, still radiation)

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25
Q

Treatment of brain metastases (3)

A

Steroids,
Anticonvulsants
Radiotherapy

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26
Q

3 localised lesions/space occupying lesions that cause raised ICP

A

Haemorrhage
Tumour
Abscess

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27
Q

Name a generalised (i.e. not localised) lesion that causes raised ICP

A

Oedema post trauma

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28
Q

Consequences of space occupying lesions leading to raised ICP (3)

A

Increases amount of tissue in the skull so unstable ICP
Internal shift between the intracranial spaces
Local ischaemia as tumours squeeze nearby tissue

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29
Q

Internal shift (herniation) between the intracranial spaces can shift in what directions (4)

A

Right –> left
Left –> right
Cerebrum can move inferiorly over edge of tentorium cerebelli (tentorial herniation)
Cerebellum can move inferiorly down forage magnum (coning)

30
Q

What is subfalcine herniation (2)

A

MIDLINE SHIFT:

Cingulate gyrus pushed to one side and herniates underneath the falx to the other side

So falx cerebri is pushed to one side as well

31
Q

What is tentorial/uncal herniation (3)

A

Brain herniates inferiorly over the side of the tentorium cerebelli –> pushing the brainstem medially –> narrowing the cerebral aqueduct

32
Q

What is cerebellar tonsillar herniation (3)

A

Tonsils move medially and inferiorly down foramen magnum –> crushing the brainstem –> brainstem death

33
Q

Grave complication of raised ICP

A

Brainstem death

34
Q

Primary brain tumours can be classified by cell of origin - what are the 2 subcategories

A

Tumours arising from cells inside brain, i.e. neurons or glial cells

Tumours arising from cells outside brain

35
Q

Name 3 main types of gliomas (i.e. tumours arising from glial cells)

A

Astrocytoma
Oligodendroglioma
Ependymoma

36
Q

Name a common astrocytoma

A

Glioblastoma multiforme

37
Q

How are astrocytomas graded

A 
Low grade (slow growing)
High grade (Fast growing)

or

Grades 1 - 4

38
Q

What grade astrocytoma is a glioblastoma multiforme

A

Grade 4

39
Q

Name a tumour arising from embryonic neural cells

A

Medulloblastoma (childhood malignant tumour)

40
Q

Name 5 primary brain tumours arising from cells outside the brain (i.e. not arising from neurons or glial cells)

A 
Meningioma
Schwannoma
Pituitary adenoma
Lymphoma
Haemangioblastoma
41
Q

What cells do mengiomas arise from

A

Arachnoid cells

42
Q

What vessels do haemangioblastomas arise from

A

Capillaries

43
Q

Brain tumours in adults are mostly above what fold of dura

A

Tentorium cerebelli

44
Q

Brain tumours in children are mostly BELOW what fold of dura

A

Tentorium cerebelli

45
Q

Are gliomas encapsulated

A

No

46
Q

Do gliomas metastasise outside CNS

A

No

47
Q

What cells are GBMs derived from

A

Astrocytes

48
Q

Histological appearance of low grade astrocytomas (slow growing)

A

Bland cells, similar to normal astrocytes

49
Q

Histological appearance of high grade astrocytomas (slow growing)

A

Large abnormal astrocytes with multiple/irregular nuclei

50
Q

Histological appearance of meningiomas

A

Bland cells clustering together –> ARACHNOID GRANULATION

Psammoma - calcified clustered cells

51
Q

Do meningiomas metastasis

A

No

52
Q

Are meningiomas usually being or malignant

A

Benign

53
Q

Medulloblastomas affect who most

A

Children

54
Q

Medulloblastomas usually found in what fossa + are they usually benign/malignant

A

Posterior

Malignant

55
Q

Histology of medulloblastomas

A

Layers of undifferentiated cells

56
Q

Nerve sheath tumours only affect nerves where

A

Nerves in the PNS, i.e. peripheral nerves covered by Schwann cells

57
Q

A common schwannoma is schwannoma of CN VIII - what is it also known as

A

Acoustic neuroma

58
Q

Main clinical feature of acoustic neuromas (benign)

A

Unilateral sensorineural hearing loss

59
Q

CNS lymphomas are usually lymphomas of what cells

A

B cells

60
Q

Haemangioblastomas are most often found where in the brain

A

Cerebellum

61
Q

Are schwannomas usually benign or malignant

A

Benign

62
Q

What is a psammoma

A

Calcified cluster of arachnoid cells that can occur with meningiomas

63
Q

Treatment of pituitary adenomas (3)

A

Trans-sphenoidal resection of tumour
Radiotherapy if there’s residual tumour after surgery
Hormone replacement

64
Q

Treatment of acoustic neuroma (2)

A

Focused radiotherapy (stereotactic radiosrugery)

or surgery

65
Q

Symptoms of a medulloblastoma (Childhood malignant tumour) (4)

A

morning headaches,
nausea/vomiting
Visual disturbance - diplopia
Behavioural changes

66
Q

Symptoms/signs of a meningioma (4)

A

Often ASYMPTOMATIC until large (symptoms come from mass effect)

Headache
Neurological deficit - visual impairment, hearing/smell impairment, muscle weakness
Seizure

67
Q

Where are acoustic neuromas often anatomically found

A

At the cerebellopontine angle

68
Q

Symptoms/signs of astrocytomas, e.g. GBM (7)

A 
SEVERE morning headache
Nausea/vomiting
Visual disturbance - diplopia, visual field cut, visual acuity loss
Seizures
Motor weakness
Dysphasia
69
Q

Can get spontaneous … without nausea in brain tumours

A

Vomiting

70
Q

Symptoms/signs of frontal lobe tumours (4)

A

Behaviour + personality change
Loss of concentration and judgement
Memory impairment
Headache

Year 2 - Nervous (39 decks)

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