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Neurology > Brain Tumours > Flashcards

Brain Tumours Flashcards

1
Q

What is the most common extra-axial tumour

A

Meningioma

Benign tumour

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2
Q

Give examples of extra-axial tumours

A 
Meningioma 
Pituitary adenoma 
Acoustic neuroma or vestibular schwannoma 
Choroid plexus papilloma 
Craniopharyngioma
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3
Q

How do brain tumours cause raised ICP

A

Additional mass within the closed box of the skull
Can cause mass effect, blockage of CSF flow or haemorrhage
All will raise the pressure

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4
Q

How does raised ICP present

A

Headache,
Vomiting,
Low GCS and seizures

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5
Q

How does uncal herniation present

A

Unilateral blown pupil (dilated)

Due to compression of 3rd nerve

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6
Q

What are the signs of a tumour headache

A

Worse in the morning
The pain wakes them up
Worse on coughing and leaning forward
May be associated with vomiting

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7
Q

When would a tumour cause a headache

A

If it is pressing on the dura or periosteum
The brain itself doesn’t have pain receptors but these structures do
Can be due to raised ICP
Secondary to visual disturbances

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8
Q

What visual disturbances can tumours cause

A

Diplopia - due to compression of CNIII, IV, VI
Difficulty focusing
Blown pupil - CNIII

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9
Q

Functional symptoms of a brain tumour are related to the location - true or false

A

TRUE

Will affect the function controlled by that lobe of the brain

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10
Q

What is the sign of papilloedema

A

Loss of the optic disc on fundoscopy

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11
Q

What is the most common brain tumour

A

Metastasis from another tumour

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12
Q

What are the most common investigations for brain tumours

A 
CT 
MRI 
PET scan 
Lumbar puncture 
Angiogram 
Biopsy 
EEG
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13
Q

What are the 4 grades of astrocytic tumours

A 
I = pilocytic astrocytoma 
II = low grade astrocytoma 
III = anaplastic astrocytoma 
IV = glioblastoma multiforme
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14
Q

From which cells do glial tumours arise

A

astrocytes or oligodendrocytes

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15
Q

Describe pilocytic astrocytoma

A

Benign - slow growing
More common in children
Surgery is curative

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16
Q

Where do low grade astrocytoma most commonly affect

A

Temporal lobe

Frontal lobe - posterior and anterior sections

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17
Q

How do low grade astrocytoma’s present

A

Seizures

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18
Q

What are the poor prognostic factors for a low grade astrocytoma

A 
Age over 50
Focal deficit (seizures)  
Raised ICP
Short duration of symptoms
Altered consciousness 
Enhanced contrast studies
Incomplete resection
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19
Q

How do you treat low grade astrocytoma’s

A

Resect tumour within reason (may need to leave small areas if near a crucial structure)
If the tumour is incompletely resected then we give radiotherapy and chemotherapy
The tumour will most likely come back but they can have a good quality of life in the

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20
Q

Describe anaplastic astrocytomas

A

Malignant tumour
Median survival of <2 years
Can operate to reduce symptoms but wont cure - surgery and radiation

21
Q

Describe glioblastoma multiforme

A

malignant
most common primary tumour
survival is around 14 months regardless of treatment
Treatment to improve QoL not cure - surgery and radiation

22
Q

How can tumours be visualised for surgery

A

5AMA
Patient drinks the substance and it taken up in the brain
Shows up tumour cells as pink if blue light is shone on it

23
Q

Which chemotherapy is commonly used for brain tumours

A

Temozolomide – oral chemotherapy
PCV
Can deliver chemo onto brain itself with carmustine wafers but it does impede wound healing

24
Q

How is radiotherapy used in the treatment of brain tumours

A

Used after surgery on malignant tumours
Used if there has been incomplete resection
Used for recurrence of benign tumours

25
Q

Describe oligondendriglial tumours

A

Arise from oligodendrocytes
Affect the frontal lobes
Occur in adults 25-40
Present with seizures

26
Q

What are collision tumours

A

Oligodendroglial cells coexist with astrocytic cells in a neoplastic collision type of tumour
Both cell types in tumour

27
Q

How do you treat oligodendroglial tumours

A

Tend to be chemosentive

Treat with chemo and surgery

28
Q

How might brain tumours present in children

A

Tiptoeing, ataxia and vomiting

29
Q

How do meningiomas present

A

Most are asymptomatic

May cause headache or cranial nerve neuropathies

30
Q

Meningiomas can be induced by radiation - true or false

A

True

common after treatment for childhood leukaemia

31
Q

What is tumour blush

A

Sign seen on angiogram

Diffuse spread of contrast on image in the area of the tumour

32
Q

How do you treat meningiomas

A

Preoperative embolization
Surgery
Radiotherapy

33
Q

How do temporal lobe tumours present

A

With seizures

34
Q

How do frontal lobe tumours present

A

Personality changes

35
Q

How do acoustic neuromas present

A

Hearing loss
Tinnitus
Balance problems

36
Q

What are acoustic neuromas

A

also called vestibular schwannomas

Tumours of the 8th cranial nerve

37
Q

How do you treat acoustic neuromas

A

Hearing aids and monitoring when small
Surgery
Radiation
Hydrocephalus management

38
Q

What tumour markers must be tested in a child with a midline tumour

A

AFP, HCG and LDH

Need to check if its a germ tumour

39
Q

How can you surgically treat hydrocephalus

A

VP shunt - ventriculoperitoneal

Fluid transferred to peritoneum where it can be reabsorbed

40
Q

How do brain tumours generally present

A 
Focal symptoms - dependant on location 
Headache 
Vomiting 
Seizures 
Visual disturbance 
Papilloedema
41
Q

Where do most childhood brain tumours occur

A

below the tentorium cerebelli

42
Q

What types of cancer most commonly metastasise to the brain

A 
Breast 
Bronchus 
Kidney 
Thyroid 
Colon 
Metastatic melanomas
43
Q

Where in the brain are mets often found

A

Boundaries between grey and white matter

44
Q

Benign brain tumours usually don’t cause much of a problem - true or false

A

FALSE

Can still cause significant symptoms due to compression of brain

45
Q

High grade malignant brain tumours often don’t metastasise - true or false

A

TRUE

46
Q

Describe medulloblastoma

A

2nd most common tumour in kids
Poorly differentiated
Occurs in the midline
Radiosensitive - good survival with resection and radiotherapy

47
Q

If you suspect a headache is caused by a brain tumour, what is the first test you can do in clinic to confirm

A

Fundoscopy - look for papilloedma

48
Q

If someone is found to have multiple brain mets, what should you do

A

Urgent CT chest, abdo, pelvis to look for the primary

Neurology (18 decks)

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