Brain Tumours Flashcards
how do brain tumours present
progressive neurological defect
usually motor weakness
headache (raised ICP)
seizures
causes of increased intra cranial pressure
increased brain tissue
increased blood
increased CSF
signs of raised ICP
headache
vommiting
seizures
GSC change
what nerve does uncle herniation press on
CNIII
causes a 3rd nerve palsy with a down and out pupil
headache which suggest brain tumour
wakes them up in the morning, increases with coughing/leaning forward
may be associated with increased vomiting
DO FUNDOSCOPY - look for papilloedema
what causes a headache with tumour
raised ICP Invasion/compression of dura, BVs, periosteum Secondary to diplopia secondary to difficulty focussing extreme hypertension psychogenic causes
what does papillodema look like
loss of definition between cup and retina
Investigations for brain tumours
CT MRI LP PET Lesion biopsy EEG Evoked potentials Angiograms Radionucleotide studies Papilloedema (v late sign so already v bad)
most common brain tumour
metastasis
what cells cause primary brain tumours
Astrocytes
Oligiodendroglial cells
ependymal cells
neuronal cells
LOOK AT THE SLIDES FOR WHO BRAIN TUMOUR GRADING
could be in finals etc
Grade 1- astocytomas
benign slow growing children, young adults pilocytoc astrocytomas optic nerve, cerebellum generally
treatment - surgery
Grade 2 astrocytoma
‘low grade’
fibrillary, gemistocytic, protoplasmic
go to:
temporal
frontal
parietal lobes
present with seizures
not benign - dedifferentiation to high grade malignancy
poor prognostic factors for grade 2 astrocytomas
Age >50 focal deficit (seizures) short duration of symptoms raised ICP altered consciousness enhancement on contrast studies
treatment - SURGERY - excise tumour early while still small
how to tell apart grade 1 and 2 astrocytoma
grade 1 - bright white
grade 2 - not as bright
what are the ‘malignant’ astrocytomas
grades III-IV
anaplastic astrocytoma
-median survival - 2 years
Glioblastoma multiform
- most common primary tumour
median survival <1 year
can spread along white matter tracking CSF pathways
treatment for malignant astrocytomas
Surgery (non-curative)
- cytoreduction
- reduce mass effect
+ chemo and radio
why can’t you drive after a brain surgery
due to risk of seizures - can’t drive for 6 months
oligiodenroglial tumours I
20% of glial cells
present with seizures
frontal lobe
convert to malignancy
treatment for oligodendroglial tumours
chemo
surgery
radial
mean survival - 10 years
RED FLAGS
head ache wakes u up +/- vomiting, new neurological deficit, seizures
tiptoeing, ataxia, committing with headache in children
always refer to macmillan nursing
what are meningioma tumours
arachnoid cap cells
extracial
20% of intracranial neoplasms
majority asymptomatic
curative
presentation of meningiomas
headache
cranial nerve palsy
seizures
aggressor meningiomas
clear cell
choroid
rhabdois
papillary
(CRAP) - more likely to recur
treatment for meningiomas
small meningiomas - leave alone preoperative embolisation surgery radiotherapy recurrance
investigation of meningiomas
CT
MRI
Angiography
Nerve sheath tumours
schwanomas
neurofibromas
malignant peripheral nerve sheath tumours
acoustic neuroma
vestibular schwannomas
seen in neurofibromatosis II (if both sides)
hearing loss
tinnitus
disequilibrium
treatment for acoustic neuroma
Leave alone - v slow growing
in massive needs:
radiation
surgery
hydrocephalus management
pineal tumours
present with paranoid syndrome??
Tumour markers to look for in brain tumours
AFP
HCG
LDH
if negative do a biopsy
treatment for hydrocephalus
VP shunt
visceral peritoneal shunt
pituitary tumours
do early morning cortisol
prolactin
