Brain Tumours

Question 1

what is uncal herniation

Answer 1

when the brain moves inferiorly under the tentorium cerebelli

Question 2

what is coning

Answer 2

cerebellum moving out through foramen magnum

Question 3

which part of the cerebellum herniates in coning

Answer 3

tonsils

Question 4

true/false tumours cause ischaemia

Answer 4

true - they push and squeeze nearby tissue and cut off its supply

Question 5

what is papilledema

Answer 5

visual disturbance caused by raised ICP swelling the optic nerve in the eye (can be seen on fundoscopy)

Question 6

which of the following doesn’t commonly occur with raised ICP:

a. morning headaches
b. papilloedema
c. pupil dilation
d. falling GCS
e. brain stem death
f. diarrhoea

Answer 6

f. diarrhoea

Question 7

tumour of pituitary

Answer 7

adenoma

Question 8

tumour of nerve sheath cell in periphery

Answer 8

schwannoma

Question 9

where are most CNS tumours in adults, above or below the tentorium cerebelli?

Answer 9

above

Question 10

list the 5 common brain tumours we need to know

Answer 10

astrocytoma (glioma)
medulloblastoma
meningioma
schwannoma
pituitary adenoma

Question 11

what is somnolence

Answer 11

drowsiness, reduced consciousness

Question 12

true/false raised ICP headaches are worse leaning forwards

Answer 12

true - also maybe in the morning

Question 13

which is most medial on the motor homunculus, leg or face

Answer 13

leg

Question 14

if someone has ataxia where would you suspect the lesion

Answer 14

cerebellum

Question 15

true/false left handed people are right hemisphere dominant

Answer 15

false - 60% of lefties are left hemisphere dominant

Question 16

which hemisphere is dominant in right handed people

Answer 16

left hemisphere

Question 17

someone has:
1. difficulty reading emails
2. difficulty expressing what he wants to say
3. short term memory impairment
4. 6 weeks of rib pain
5. PMH of renal cell carcinoma
where do you suspect a lesion?

Answer 17

left temporo-parietal area

Question 18

common metastatic origins for brain metastases

Answer 18

breast, lung, melanoma, kidney, colon

Question 19

medical treatment of DVT

Answer 19

warfarin/anticoagulant

Question 20

basic investigations of brain tumour

Answer 20

CT/MRI with/out contrast and biopsy

Question 21

scans that can be used for cerebral tumour

Answer 21

CT, MRI, PET

Question 22

how are gliomas graded

Answer 22

I-IV according to their rate of growth, with I being the slowest growing

Question 23

routes of treatment for a primary brain tumour

Answer 23

surgery
steroids and anticonvulsants
radio
chemo

Question 24

features of a raised ICP headache

Answer 24

in the morning, worse leaning forward, coughing or sneezing

Question 25

what do anticonvulsants treat in a brain tumour

Answer 25

the epileptic fits

Question 26

life expectancy of a high grade astrocytoma (glioblastoma multiforme)

Answer 26

1 year

Question 27

consequences of doing an LP in suspected brain lesion

Answer 27

1. might cause meningitis
2. might cause coning
3. might cause air embolism
4. make headache worse