Brain Tumours

Question 1

Raised ICP

Answer 1

• Presentation
  
  • Headache (constant, nocturnal, worse on waking, worse on coughing/straining/bending forward, vomiting)
  • Altered mental state
  • Visual field defects
  • Unilateral ptosis
  • 3rd and 6th nerve palsies
  • Papilloedema (on fundoscopy)

Question 2

Papilloedema

Answer 2

• Blurring of the optic disc margin
• Elevated optic disc (look for the way the vessels flow across disc for elevation)
• Loss of venous pulsation
• Engorged retinal veins
• Haemorrhages around optic disc
• Paton’s lines which are creases in the retina around the optic disc

Question 3

Types of brain tumour

Answer 3

• Common cancers that metastasise to brain are:
  
  • Lung
  • Breast
  • Colorectal
  • Prostate
• Gliomas
  
  • Tumour of glial cells (three types from most to least malignant)
    
    • Astrocytoma (glioblastoma multiforme)
    • Oligodendroglioma
    • Ependymoma
• Meningioma
  
  • Tumour of the meninges
  • Usually benign
• Pituitary tumours
  
  • Cause bitemporal hemianopia
  • Can lead to hormone deficiencies or release of excess hormones:
    
    • Acromegaly
    • Hyperprolactinaemia
    • Cushing’s disease
    • Thyrotoxicosis
  • Manageed using trans-sphenoidal surgery or radiotherapy
• Acoustic neuroma (or vestibular schwannoma)
  
  • Tumour of schwann cells in auditory nerve
  • Associated with NF type 2
  • Symptoms include hearing loss, tinnitus and balance problems
  • Can also cause facial nerve palsy