Brain tumours

Question 1

Common types of primary brain tumours

Answer 1

neuroepitheal tissue - glioma (glioblastoma multiforme)

meninges - meningioma

pituitary - adenoma

Question 2

Common tumours that spread to the brain (5)

Answer 2

renal cell carcinoma

lung carcinoma

breast carcinoma

malignant melanoma

GI tract

Question 3

What is the most common brain tumour?

Answer 3

metastases

Question 4

Gliomas are derived from which glial cell

Answer 4

astrocytes

Question 5

How are Gliomas graded

Answer 5

1-4

grade 4 is most common and most aggressive. Glioblastoma multiforme - spread by tracking through white matter and CSF pathway - very rarely spread systemically

Question 6

Characteristics of Meningiomas (6)

Answer 6

slow growing

extra-axial - outside the brain - compress the brain from the meninges

usually benign

arise from arachnoid

frequently occur along
falx, convexity, or sphenoid bone

usually cured if completely removed

Question 7

Pituitary tumours

Answer 7

adenoma most common
only 1% malignant

present with visual disturbance due to compression of optic chiasm or hormone imbalance

Question 8

Which visual field loss is there usually associated with a pituitary tumour

Answer 8

bitemporal hemianopia

Question 9

Clinical presentation of a tumour within the cerebrum

Answer 9

raised intracranial pressure

focal neurological deficit

epileptic fits

CSF obstruction

Question 10

Symptoms due to raised ICP

Answer 10

headache - typically morning

nausea/vomiting

somnolence - drowsy

visual disturbance (diplopia, blurred vision)

cognitive impairment

altered consciousness

Question 11

Signs of raised ICP (5)

Answer 11

papilloedema - optic disc swelling

6th nerve palsy - abudcens - causes squint, double vision etc

cognitive impairment

altered consciousness

3rd nerve palsy - oculomotor

Question 12

What is involved in reaching a diagnosis of a brain tumour

Answer 12

History + examination

Secondary tumour source? CXR

CT

MRI

Biopsy

Question 13

What is a focal neurological deficit

Answer 13

a problem with nerve, spinal cord, or brain function.

It affects a specific location, such as the left side of the face, right arm, or even a small area such as the tongue. Speech, vision, and hearing problems are also considered focal neurological deficits.

Question 14

Examples of focal neurological deficits (6)

Answer 14

hemiparesis

dysphasia

hemianopia

cognitive impairment (memory, sense of direction)

cranial nerve palsy - 6th nerve most common

endocrine disorders - pituitary tumour

Question 15

A 66 year old, left handed, woman presents with ataxia and in-coordination. Where would you suspect her lesion to be?

Answer 15

Cerebellum

Question 16

A 44 year old, right handed, woman presents with acalculia, agraphia,
finger agnosia and right/left confusion.

Where would you suspect
her lesion to be?

Answer 16

Left parietal lobe

Question 17

Cerebral lesions can present with epilepsy but only above which point?

Answer 17

tentorium cerebelli

Question 18

Adequate cerebral imaging

Answer 18

CT
MRI
PET - rare - only used if metastases is suspected and primary is not known

meningiomas are very vascular - not common but could do angiography for this

Question 19

what investigations can be carried our if metastasis is suspected?

Answer 19

CT chest/abdo/pelvis

Mammography

biopsy skin lesions/ lymph nodes

Question 20

Management options for brain tumours

Answer 20

corticosteroids 
treat epilepsy 
analgesics/antiemetics
counselling
radiotherapy 
chemotherapy 
endocrine replacement

Question 21

Management of Glioblastoma multiforme (GBM)

Answer 21

complete surgical excision impossible
- biopsy or debulk only

medical - Steroids, anticonvulsants

radiotherapy

chemo - temazolamide

Question 22

Management of metastasic tumours

Answer 22

medical - steroids, anticonvulsants

radiotherapy - whole brain, steriotactic (more precise)

surgery

Question 23

Prognosis: Meningioma

Answer 23

commonly cured by surgery - may require anticonvulsants

Question 24

Prognosis: high grade astrocytomas e.g GBM

Answer 24

average 1 year survival

Question 25

When must you NOT do a lumbar puncture and why

Answer 25

when there are signs and symptoms to suggest an intracranial mass lesion - Increased ICP

You might cause a herniation syndrome (coning through foramen magnum) and the patient could die