Brain Tumours Flashcards
What are the 2 general types of brain tumour?
Primary
Secondary metastatic
In primary tumors, what are the different type?
Glioblastoma
Meninges
Pituitary
What are the commonest tumours which spread to the brain?
Renal cell Breast Lung Malignant melanoma GI tract
What is the most common type of brain tumour?
Metastatic brain tumours
What cells are gliomas derived from?
Astrocytes
What stage is a GBM?
Stage IV
What are classed as primary malignant tumours?
Gliomas
In which meningeal layer do meningiomas usually present
Arachnoid
Where fo meningiomas usually present in the brain?
Along falx, convexity or sphenoid bone
Are meningiomas curable?
Yes by surgical excision
What is the common signs of pituitary adenoma?
Optic field defect - bitemporal hemianopia
hormone imbalance
What are the clinical presentations of a brain tumour?
Raised intracranial pressure
Focal neurological signs
Epileptic fit
CSF obstruction
What are the main symptoms of raised ICP?
Headache Nausea/ vomiting Diploia or blurred vision Drowsiness Cognitive impairment Alter consciousness
What are the signs of raised ICP?
Papilloedema
3rd nerve palsy
6th nerve palsy
Altered consciousness
What is a RED FLAG sign of raised intracranial pressure?
Headache - worse in morning
What investigations would you do if suspected brain tumour?
CT scan (brain)
MRI
PET
CXR
Biopsy - skin or lymph
Mammography
What are some focal neurological deficits which may be observed?
Dysphagia Hemiparesis Hemianopia Cognitive impairment Cranial nerve palsy Endocrine disorders
Patient presents with ataxia & incoordination, where is the lesion?
Cerebellum
Right handed patient presents with acalculia, agraphia, finger agnosia, left/ right confusion, where is the lesion?
Left parietal lobe
If patient presents with bitemporal hemianopia, where is the lesion?
Pituitary
If right handed patient presents with difficulty reading, difficulty expressed self, short term memory loss, where is the lesion?
Left temper-parietal area
What are the main management goals?
Reduce size of tumour (debunk)
Improve focal neurological signs
What type of management is available?
Steroids
Anticonvulsants
SuRgery
Radiotherapy
Are GBM operable?
Yes but not curative only debulk or biopsy
What treatment would be administered in someone with metastatic brain tumours?
Surgery
Radiotherpay
What is the prognosis for GBM?
1 YRS
What is the prognosis for meningioma?
Commonly cured with surgery
What is the prognosis for metastatic disease?
Medium term remission
Why do you NOT perform lumbar puncture in someone with brain tumour?
Risk of herniation syndrome and patient death
What tumours are classed as primary benign?
Pituitary adenoma
Meningioma
What are the presenting signs of brain tumour?
Raised ICP - nausea, headache, drowsiness
Focal neurological signs
Cognitive impairment
What are the names of the dural sheets which divide the brain?
Falx cerebri
Tentorium cerebelli
What are the localised lesion causes of increased intracranial pressure?
Haemtoma (haemorrhage)
Tumour
Abscess
What are some of the generalised causes of increased ICP?
Oedema post trauma
What are localised lesions also referred to as?
Space Occupying Lesions (SOL)
What types of herniation can occur what increased ICP?
Uncal herniation
Subfalcine (midline shift)
Coning - cerebellotonsillar herniation
Why is it called a subfalcine shift?
Falcine means falx therefore below falx cerebri
In an uncle herniation what happens?
Brain herniates inferiorly below tentorium
Cerebellar tonsil herniation causes what?
Brain stem death
What are some of the initial signs & symptoms of Increased ICP?
Morning headache & nausea
Papilloedema
What are some of the progressive signs of increased ICP?
Pupillary dilation
Falling GCS score
Brainstem death
What are the different types of gliomas?
Glioblastoma
Astrocytoma
Oligodendroctoma
Ependymoma
What is the cell type found in medulloblastomas?
Embryonic neural cells
What are meningiomas formed from?
Arachnoid cell
What tumours occur from nerve sheath cell?
Neurofibroma
Schwannoma
What tumour arises from blood vessels?
Haemangioblastoma
Which tumour type is a malignant childhood tumour?
Medulloblastoma
Where do the majority of brain tumours occur in adults/children?
Above tentorium
Below tentorium
Which cells do gliomas descend from?
Glial cells
Are gliomas malignant or benign?
Malignant
Which cells are glioblastomas formed from?
Astrocytes
What shape do astrocytes look like?
Star shaped
Where are medulloblastomas usually found?
In posterior fossa, in children
Are meningiomas benign or malignant?
Malignant
Where are schwannomas found?
Peripheral nerve sheaths
What is an acoustic neuroma?
Schwannoma of the 8th cranial nerve
What is the main sign of an acoustic neuroma?
Unilateral hearing loss
What is a pituitary adenoma?
Benign tumour of the pituitary gland
