Brain Tumours Flashcards
Causes of raised ICP? [4]
Localised (Space Occupying) Lesions
- Haemorrhage or haematoma
- Tumour
- Abscess
Also Oedema post trauma
Types of herniation due to raised ICP? [3]
Internal Shift or Herniation:
- Right-left e.g. subfalcine herniation (cingulate gyrus herniates under falx)
- Uncal Herniation (cerebrum moves down over tentorium)
- Coning (Cerebellum, mainly tonsils, moves into foramen magnum)
What happens to tissue around a tumour? [1]
Ischaemia
Early symptom of a raising ICP via 2 mechanisms [3]
Morning Headaches and vomiting from cortex/brainstem compression
Papilloedema & Visual Disturbance from pressure on optic nerve
What other signs appear as ICP increases? [5]
- Pupillary Dilation from stretch on III
- 6th nerve palsy
- Focal Neurological Deficits
- Falling GCS from pressure on Cortex/brainstem
- Brain Stem Death from coning
Intracranial tumours can be divided into 3 major categories?
- Primary CNS tumours
- Secondary (Metastatic) CNS tumours
- Extra-axial tumors CNS
Types of intra-axial tumours [4]
Gliomas
Ependymomas
Medulloblastoma
CNS lymphoma
What cancers commonly metastasise to the brain? [5]
- Breast
- Lung
- Kidney
- Colon
- Melanoma
Where anatomically in the brain would you find tumours in adults vs in children?
Adults - Above Tentorium
Children - Mainly below Tentorium
Astrocytoma = Glioma
Infiltrative tumours from glial cells
Low grade vs High grade
What difference in demographic are there?
Low grade include grade 1-2 astrocytomas
* Young adult and children
High grade include grade 3-4 astrocytomas
* Present in older adults in 4th-5th decades of life
What cell do glioblastomas and astrocytomas originate from?
What low grade glioma is benign? [1]
Both from Astrocytes
Low grade pilocytic astrocytomas are malignant while low grade gliomas are generally pre-malignant
Glioblastoma vs astrocytoma
What are similarities [2]
Whats the difference [3]
Both originate from astrocytes & are malignant
Astrocytomas:
- Bland mostly normal cells
- Low Grade tumour
- Grows very slowly
Glioblastoma
- Cellularly Atypical (multiple or irregular nuclei)
- Grows very quickly
- Grade 4 astrocytoma
- Shows necrosis microscopically
What does a medulloblastoma originate from?
Primitive Neuroectoderm (primitive Neural cells)
Describe a medulloblastoma?
- Forms sheets of small undifferentiated cells
- Malignant
Medulloblastoma
Which age group usually affected?
Arising from what cell?
Presentation
Location of tumour
Treatment
20% of all childhood CNS tumour
Arise from granule cell progenitors
5% are inherited or genetic related
Present with headache, ataxia, signs of brainstem involvement
Usually seen in posterior fossa in MRI
Tx: surgery + craniospinal irradiation, chemo
Meningioma
Epidemiology
Arise from what cells
Location
Classification: name 3 grades
Incidence increases with age, women, NF2, hx of cranial irradiation therapy
Arise from dura mater, neoplastic meningothelial cells
Located over cranial convexities, adjacent to sagittal sinus, skull base, spinal cord dorsum.
Grade 1: benign
Grade 2: atypical
Grade 3: Malignant
Meningioma
Presentation
Appearance on MRI
Mx
Presentation: headaches, seizures, focal neurologic deficits
Imaging: partially calcified, densely enhancing extra-axial tumour arising from dura, with dural tail.
Mx: complete resection usually results in no recurrence, +/- stereotactic radiotherapy
What do we call the calcifications of a meningioma seen under microscope?
Psammoma body formation
Give one major example of a schwannoma? Location? [2]
VIII nerve Schwannoma (Acoustic Neuroma)
Generally at angle of Pons & Cerebellum
Schwannoma
Arise from nerve roots so can be cranial nerve or spinal nerve.
Most known is the vestibular schwannoma/acoustic neuroma assoc with NF2. NF1 assoc with schwannoma in spinal nerve roots.
Presenting with unilateral symptoms, deafness, dizziness, tinnitus.
Mx: surgery or SRS
What does a pituitary adenoma do? [2]
- Impinge on optic chiasm
- Dysregulation of pituitary hormone secretion