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3 Neurology > Brain Tumours > Flashcards

Brain Tumours Flashcards

1
Q

how do brain tumours present

A

progressive neurological defect
usually motor weakness
headache (raised ICP)
seizures

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2
Q

causes of increased intra cranial pressure

A

increased brain tissue
increased blood
increased CSF

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3
Q

signs of raised ICP

A

headache
vommiting
seizures
GSC change

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4
Q

what nerve does uncle herniation press on

A

CNIII

causes a 3rd nerve palsy with a down and out pupil

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5
Q

headache which suggest brain tumour

A

wakes them up in the morning, increases with coughing/leaning forward

may be associated with increased vomiting

DO FUNDOSCOPY - look for papilloedema

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6
Q

what causes a headache with tumour

A 
raised ICP 
Invasion/compression of dura, BVs, periosteum 
Secondary to diplopia 
secondary to difficulty focussing 
extreme hypertension 
psychogenic causes
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7
Q

what does papillodema look like

A

loss of definition between cup and retina

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8
Q

Investigations for brain tumours

A 
CT 
MRI 
LP 
PET 
Lesion biopsy 
EEG
Evoked potentials 
Angiograms 
Radionucleotide studies 
Papilloedema (v late sign so already v bad)
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9
Q

most common brain tumour

A

metastasis

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10
Q

what cells cause primary brain tumours

A

Astrocytes
Oligiodendroglial cells
ependymal cells
neuronal cells

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11
Q

LOOK AT THE SLIDES FOR WHO BRAIN TUMOUR GRADING

A

could be in finals etc

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12
Q

Grade 1- astocytomas

A 
benign 
slow growing 
children, young adults 
pilocytoc astrocytomas 
optic nerve, cerebellum generally

treatment - surgery

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13
Q

Grade 2 astrocytoma

A

‘low grade’
fibrillary, gemistocytic, protoplasmic

go to:
temporal
frontal
parietal lobes

present with seizures

not benign - dedifferentiation to high grade malignancy

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14
Q

poor prognostic factors for grade 2 astrocytomas

A 
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

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15
Q

how to tell apart grade 1 and 2 astrocytoma

A

grade 1 - bright white

grade 2 - not as bright

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16
Q

what are the ‘malignant’ astrocytomas

A

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

17
Q

treatment for malignant astrocytomas

A

Surgery (non-curative)

  • cytoreduction
  • reduce mass effect

+ chemo and radio

18
Q

why can’t you drive after a brain surgery

A

due to risk of seizures - can’t drive for 6 months

19
Q

oligiodenroglial tumours I

A

20% of glial cells
present with seizures
frontal lobe

convert to malignancy

20
Q

treatment for oligodendroglial tumours

A

chemo
surgery
radial

mean survival - 10 years

21
Q

RED FLAGS

A

head ache wakes u up +/- vomiting, new neurological deficit, seizures

tiptoeing, ataxia, committing with headache in children

always refer to macmillan nursing

22
Q

what are meningioma tumours

A

arachnoid cap cells
extracial
20% of intracranial neoplasms
majority asymptomatic

curative

23
Q

presentation of meningiomas

A

headache
cranial nerve palsy
seizures

24
Q

aggressor meningiomas

A

clear cell
choroid
rhabdois
papillary

(CRAP) - more likely to recur

25
Q

treatment for meningiomas

A 
small meningiomas - leave alone 
preoperative embolisation 
surgery 
radiotherapy 
recurrance
26
Q

investigation of meningiomas

A

CT
MRI
Angiography

27
Q

Nerve sheath tumours

A

schwanomas
neurofibromas
malignant peripheral nerve sheath tumours

28
Q

acoustic neuroma

A

vestibular schwannomas
seen in neurofibromatosis II (if both sides)

hearing loss
tinnitus
disequilibrium

29
Q

treatment for acoustic neuroma

A

Leave alone - v slow growing

in massive needs:
radiation
surgery
hydrocephalus management

30
Q

pineal tumours

A

present with paranoid syndrome??

31
Q

Tumour markers to look for in brain tumours

A

AFP
HCG
LDH

if negative do a biopsy

32
Q

treatment for hydrocephalus

A

VP shunt

visceral peritoneal shunt

33
Q

pituitary tumours

A

do early morning cortisol

prolactin

3 Neurology (9 decks)

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