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Neurology SOH > Brain Tumours > Flashcards

Brain Tumours Flashcards

1
Q

Children are more likely to get supratentorial/infratentorial tumours?

A

Infratentorial

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2
Q

Benign tumours can kill. Why is this?

A

Simply due to their location within the brain

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3
Q

Secondary brain tumour - definition

A

Brain mets

often from breast, lung, kidney, thyroid

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4
Q

Which is most common: primary or secondary brain tumours?

A

Secondary brain tumours

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5
Q

Pathophysiology

A

Since the skull is rigid, if a tumour grows it has nowhere to go.
when a tumour is walnut sized the brain can’t compensate any further and there is a sudden increase in ICP.

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6
Q

Warning clinical features of raised ICP

A 
Headache 
Papilloedema (fundoscopy)
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7
Q

In adults, most tumours arise from above/below the tentorium cerebelli

A

Above

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8
Q

In children, most tumours arise from above/below the tentorium cerebelli

A

Below

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9
Q

What is the most common type of tumour in children?

A

Medulloblastoma

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10
Q

Clinical features

A 
Progressive, focal neurological deficit 
Headache 
Nausea and vomiting 
Motor weakness
Seizures 
Personality changes
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11
Q

Clinical features - headache

A 
Worse on lying down 
Worse with coughing 
Worse leaning forward 
Wakes patient up at night 
Worse in the morning
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12
Q

Focal neurological deficit - frontal lobe symptoms

A

Contralateral motor weakness (motor strip located here)
Personality changes
Urinary incontinence (Disruption of micturition inhibition centre)
Expressive dysphasia (Broca’s area)
Seizures

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13
Q

Focal neurological deficit - temporal lobe

A 
Memory deficits 
Receptive dysphasia (Wernike's area) 
CN III palsy 
Blown pupil - unopposed sympathetic supply to the pupil
Seizures
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14
Q

Focal neurological deficit - parietal lobe

A 
Contralateral sensory weakness (sensory strip located here) 
Dyscalculia 
Dysgraphia 
Finger agnosia 
Left-right disorientation
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15
Q

Focal neurological deficit - occipital lobe

A

Visual symptoms

Contralateral homonymous hemianopia

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16
Q

Focal neurological deficit - cerebellum

A 
Ipsilateral ataxia 
N+V 
Intention tremor 
Slurred speech 
Dizziness and vertigo
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17
Q

Tonsilar herniation - symptoms

A

Cushings triad

  • hypertension
  • bradycardia
  • drop in GCS
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18
Q

Tonsilar herniation - emergency management

A

Diuretic (mannitol)

Surgery

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19
Q

Investigations

A

Fundoscopy
MRI scan
CT scan
Biopsy

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20
Q

First line investigation (and why)

A

Fundoscopy

- looks for papilloedema

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21
Q

Management options

A

Surgery
Chemotherapy
radiotherapy

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22
Q

Management - chemotherapy

A

Temozolomide
PCV
Carmustine wafers

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23
Q

Meningioma - definition

A

Benign
Slow growing
Growth of meninges

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24
Q

Which cells does meningioma arise from?

A

Mesenchymal cells

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25
Q

Meningioma - extrinsic/intrinsic tumour?

A

Extrinsic tumour

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26
Q

Meningioma usually infiltrates the brain. True or false?

A

False

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27
Q

Patients with neurofibromatosis type 2 are prone to which brain tumour?

A

Meningioma

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28
Q

Histologically benign, well demarcated tumour of the meninges. What is the diagnosis?

A

Meningioma

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29
Q

Meningioma - who gets it?

A

Elderly patients
Patients with neurofibromatosis type 2
Patients who experienced radiation in childhood

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30
Q

Meningioma - clinical features

A

Mainly asymptomatic
Headaches (due to raised ICP)
CN neuropathies

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31
Q

Meningioma - investigations

A

CT
- densely enhancing oedema
MRI
- patency of dural sinuses

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32
Q

Meningioma - management

A

Angiography +/- embolisation
Surgery
Radiotherapy

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33
Q

Meningioma - embolisation. Which arteries can you NOT embolise?

A

End arteries (eg ophthalmic artery)

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34
Q

What is the most common subtype of brain tumour in adults?

A

Astrocytoma (glioma)

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35
Q

Grade 1 glioma/astrocytoma

A

Truly benign
Low grade
Slow growing

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36
Q

Grade 1 glioma/astrocytoma - morphological features

A

Long hair like processes

Cystic areas

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37
Q

Grade 1 glioma/astrocytoma - mainly affects younger/older people?

A

Younger

- children, young adults

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38
Q

Grade 1 glioma/astrocytoma - common location in the brain

A

Cerebellum

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39
Q

Grade 1 glioma/astrocytoma - clinical features

A 
Progressive headache 
Cerebellar involvement 
- wide based ataxia 
- difficulty speaking (staccato speech) 
- intention tremor
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40
Q

Grade 1 glioma/astrocytoma - investigations

A

MRI scan

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41
Q

Grade 1 glioma/astrocytoma - management

A

Maximal resective surgery

42
Q

Grade 2 glioma/astrocytoma - truly benign. True or false?

A

False

  • benign but it will become malignant if you wait long enough
  • therefore it is classified as pre-malignant
43
Q

Grade 2 glioma/astrocytoma- common in younger/older people?

A

Younger

- young adults

44
Q

Grade 2 glioma/astrocytoma - common location

A

Temporal lobe (most common)
Posterior frontal lobe
Anterior parietal lobe

45
Q

Grade 2 glioma/astrocytoma - grow fast/slow

46
Q

Grade 2 glioma/astrocytoma - pathology

A

Cellular and nuclear atypia

47
Q

Grade 2 glioma/astrocytoma - investigations

A

MRI scan

  • early stages this should be normal
  • when there is malignant transformation there is enhancement on imaging
48
Q

Grade 2 glioma/astrocytoma - management

A

Surgery

- especially if the patient has poor prognostic factors

49
Q

Grade 3 glioma/astrocytoma - definition

A 
Anaplastic astrocytoma (malignant)
High grade glioma
50
Q

Grade 3 glioma/astrocytoma - pathology

A

Cellular and nuclear atypia

Mitotic activity

51
Q

Grade 3 glioma/astrocytoma - what could it progress to?

A

Glioblastoma multiforme

52
Q

Grade 4 glioma/astrocytoma - definition

A

Glioblastoma multiforme
High grade glioma
Malignant astrocytoma

53
Q

What is the most common primary CNS tumour?

A

Glioblastoma multiforme

54
Q

Grade 4 glioma/astrocytoma - more common in younger/older people?

A

Older (age 60-70)

55
Q

Grade 4 glioma/astrocytoma - pathology

A

Necrosis
Mitotic activity
Extreme cellular or nuclear atypia

56
Q

Describe the spread of glioblastoma multiforme

A

Spread via white matter tracts

Spread via CSF pathways

57
Q

Grade 4 glioma/astrocytoma - morphology of tumour

A

Haemorrhagic
Necrotic
Marked surrounding oedema
Midline shift

58
Q

Glioblastoma multiforme - clinical features

A

Seizures
Headaches
Bumping into things

59
Q

Glioblastoma multiforme - investigations

A

MRI scan

  • does not uniformly enhance
  • areas of necrosis

Biopsy

60
Q

Glioblastoma multiforme - management of choice is curative surgery. True or false?

A

False

  • unable to successfully remove unless it has formed a cyst
  • non-curative surgery is the management of choice
61
Q

Pilocytic astrocytoma is an example of a grade 1/2/3/4 astrocytoma/glioma?

62
Q

Frontal lobe tumour in young adult. Pathology reveals calcification and toothpaste appearance. What is the likely tumour?

A

Oligodendroglial tumour

63
Q

Oligodendroglial tumour - common location

A

Frontal lobe

64
Q

Oligodendroglial tumour - management

A

Chemosensitive

- PCV

65
Q

What is PCV triple chemotherapy?

A

Procarbazine
Lomustine
Vincristine

66
Q

Name 2 examples of nerve sheath tumours

A

Schwannomas (aka neuromas)

Neurofibromas

67
Q

Vestibular schwannoma (acoustic neuroma) - most cases are unilateral/bilateral?

A

Unilateral

68
Q

Bilateral schwannoma + young person makes you think of which diagnosis?

A

Neurofibromatosis type 2

69
Q

Vestibular schwannoma (acoustic neuroma) - age range

70
Q

Vestibular schwannoma (acoustic neuroma) - location of tumour

A

Cerebellopontine angle

71
Q

Vestibular schwannoma (acoustic neuroma) - pathology

A

Verocay bodies

72
Q

Unilateral sensorineural hearing loss, tinnitus, vertigo, headache, facial pain. What is the likely diagnosis?

A

Vestibular schwannoma

73
Q

What is the most common type of brain tumour in children?

A

Pilocytic astrocytoma

- grade 1 astrocytoma/glioma

74
Q

What is the second most common type of tumour in children?

A

Medulloblastoma

75
Q

Medulloblastoma - location

A

Midline of the cerebellum

76
Q

Medulloblastoma - management

A

Radiotherapy

77
Q

Which investigation scan is favoured in children? MRI or CT ?

A

MRI

- lower radiation exposure

78
Q

Child with a “funny face”, walking on tip toes, ataxia, developmental delay, vomiting. Where is the likely tumour?

A

Infratentorial

79
Q

Child with a midline brain tumour. It is known secrete hormones. What is the likely tumour?

A

Pineal tumour

80
Q

Pineal tumour - which hormones does it secrete

A

AFP
LDH
Beta HCG

81
Q

Germ cell tumour - more common in males/females?

82
Q

Germ cell tumour - peak incidence age

A

10-12 years old

83
Q

Which brain tumour is associated with Von Hippel Landau syndrome?

A

Haemangioblastoma

84
Q

Pituitary tumours - most commonly arise from the anterior/posterior pituitary gland?

A

Anterior pituitary gland

85
Q

Pituitary tumours - most grow upwards/downwards and press on which structure?

A

Most grow UPWARDS and press on OPTIC CHIASMA

86
Q

What inhibits prolactin production?

87
Q

Prolactinoma - mechanism

A

Dopamine inhibits prolactin production.
Tumour can cause loss of dopamine production.
When dopamine is inhibited, more prolactin is produced

88
Q

Prolactinoma - clinical features - female

A

Galactorrhoea (spontaneous breast milk production)
Menstrual irregularity
Amenorrhoea

89
Q

Prolactinoma - clinical features - male

A

Lack of libido
Impotence (due to lowered testosterone levels)
Abnormal visual fields
Headache

90
Q

Prolactinoma - investigations

A

Check prolactin concentration
MRI pituitary
Visual fields

91
Q

Prolactinoma - management

A

Dopamine agonist (cabergoline)

  • lowers prolactin levels
  • cause tumour shrinkage
92
Q

Growth hormone secreting adenoma - definition

A

Acromegaly

93
Q

ACTH secreting adenoma - definition

A

Cushing’s disease

94
Q

Non functioning pituitary adenoma

A 
TUmour in the pituitary gland which is not secreting any hormones. 
This results in : 
- hypoadrenalism
- hypothyroidism
- hypogonadism
- GH deficiency
95
Q

Which brain tumour has a characteristic butterfly appearance on MRI?

A

Glioblastoma multiforme

96
Q

A lesion in which part of the brain is likely to present with contralateral inferior quadrantopia?

A

Parietal lobe

97
Q

A lesion in which part of the brain is likely to present with contralateral superior quadrantopia?

A

Temporal lobe

98
Q

Foster kennedy syndrome - how does it arise?

A

Due to the presence of a meningioma in the olfactory groove

99
Q

Foster kennedy syndrome - how does this present?

A

Optic atrophy in the ipsilateral eye

Papilloedema in the contralateral eye

100
Q

A lesion in which part of the brain is likely to present with contralateral homoonymous hemianopia?

A

Occipital lobe

101
Q

With which tumour can verocay bodies be seen pathologically?

A

Schwannoma

102
Q

Which lobe of the brain is the micturition centre present?

A

Frontal lobe

Neurology SOH (31 decks)

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