Brain Tumours Flashcards
How do brain tumours commonly present?
- Progressive neurological deficit
- Motor weakness
- Headache
- Seizures
What are the signs of increased intracranial pressure?
Headaches, vomiting, mental changes, seizures
State the key red flag for brain tumours
Headache that wakes you up at night, is worse lying down and in the morning, worse with coughing and not relieved by pain killers
Name three types of herniation
Subfalcine
Uncal
Tonsillar
What is Cushings Triad and what is it a sign of?
Hypertension, bradycardia, irregular respiration
- a sign of impending herniation
What percentage of patients with a brain tumour have papilloedema?
<10%
How can you tell the location of a brain tumour?
The signs correlate to location in the brain
What does DANISH stand for?
Disdiadochokinesis Ataxia Nystagmus Intention tremor Slurred speech Hypotonia
State the investigations carried out on a suspected brain tumour
CT/MRI (CT easy to access but MRI gold standard) Lumbar puncture PET scan Lesion biopsy EEG Evoked potentials Angiograms Radio-nucleotide studies
Name the two main subtypes of glioma
Astrocytoma
Oligodendroglioma
How are astrocytomas classified?
Grade 1-4
Describe grade 1-4 astrocytomas
1 - Mixed glial and neuronal
2 - Low grade
3 - Anaplastic
4 - Glioblastoma
Describe grade 1 astrocytoma
Truly benign, slow growing in children/young adults homogeneous and can be cured with surgery
How do astrocytomas present in kids?
Ataxia
Tiptoe walking
Vomiting
Headache
What is a rare variant of grade 1 astrocytoma?
Pilocytic - involvement of optic nerve, hypothalamic glioma or cerebellum
Name three common sites for a grade 2 astrocytoma
Temporal lobe
Posterior frontal lobe
Anterior parietal
Describe grade 2 astrocytoma
Pleomorphic with vascular proliferation and necrosis, presents with seizures
State the factors for poor prognosis for a grade 2 astrocytoma
>50years old Focal deficit Short duration Raised ICP Enhancement Altered consciousness Progression to malignant
What is the treatment for grade 2 astrocytoma?
Surgery and PCV chemo and radiotherapy
What can happen if the astrocytoma is not treated effectively?
It can become a glioblastoma
Name the two malignant astrocytoma
- anaplastic
- glioblastoma
What is the expected survival for anaplastic astrocytoma?
2 years
Describe a glioblastoma
Most common, can occur as a primary tumour, <1 year survival spreads via white matter/CSF
How can malignant astrocytomas be managed?
Surgery - cytoreduction, reduce symptoms
Radiotherapy
TMZ chemo
All in combination give 14 month survival
What is the danger with TMZ chemotherapy?
CSF leaks can occur due to placement of chemotherapy
What is the age restriction for radiotherapy?
3 years old as it drops your IQ by 10
How do oligodendrogliomas often present and why?
Seizures due to slow growing tumour in frontal lobe
In an oligodendroglioma what is the classic appearance of subarachnoid accumulations?
Toothpaste morphology
What is a collision tumour?
Mix of astrocytic and oligodendroglial cells
What do oligodendrogliomas look like?
Calcified with cysts and peritumoral haemorrhage
Are oligodendrogliomas usually benign or malignant?
Usually low grade but can have malignant conversion
What is the treatment for oligodendrogliomas?
Surgery, PCV chemo, radiotherapy
What is the survival for oligodendroglioma?
10 years
Describe meningioma en plaque
Carpet like lesion infiltrates the dura and sometimes invades bone
Where do meningiomas originate?
Arachnoid granulations they are extra-axial
Name four common sites of meningioma
- parasagittal
- convexity
- sphenoid
- intraventricular
What are the symptoms of meningiomas?
Headaches, cranial nerve neuropathies, regional disturbance
What percentage of meningiomas are benign?
90%
What type of cancer can metastasise to the meninges?
Breast
Name four aggressors
- clear cell
- chordoid
- rhabdoid
- papillary
Where will radiation induced tumours arise?
Midline (childhood leukaemia)
How do meningiomas look on CT?
Homogeneous, dense enhancement, oedema and hyperostosis
How do meningiomas look on MRI?
Dural tail, patency of sinuses
What can help with resection of meningiomas?
Embolisation of tumour vasculature
Define tumour blush
Increasing hypervascular arterial phase and slow venous washout
How are meningiomas treated?
Surgery, radiotherapy but it may just be left
How can an acoustic neuroma present?
Hearing loss, tinnitus, dysequilibrium, 5th,7th,8th cranial nerve dysfunction, brainstem, hydrocephalus
State the buzzword for the appearance of an acoustic neuroma on imaging
Ice cream cone
How are acoustic neuromas managed?
Medically more than surgically - radiosurgery is gold standard
Post radiosurgery what are the complications?
Facial nerve Palsy
Corneal reflex
Nystagmus
Abnormal ocular movements
State the peak incidence for pineal tumours
10-12 years old
Where can pineal tumours metastasise to?
CSF
How are geminomas treated?
Radiosensitive if >3 years old
Name four non-germinatous tumours
Yolk sac
Teratoma
Choriocarcinoma
Embryonal carcinoma
What tumour markers can be used in pineal tumours?
Alpha feto-protein
Beta HCG
LDH
If tumour markers are negative what investigation is required?
Biopsy
What techniques can be used to treat hydrocephalus?
Endoscopic Third Ventriculostomy
VP Shunt
Name three key signs of pituitary tumour
- endocrine abnormality
- headache
- bitemporal hemianopia
What investigations are done in suspected pituitary tumour?
Prolactin (cabergoline can treat) GH/IFG 1 - acromegaly can cause HCOM Cortisol - cushings TSH, FSH, LH Visual fields/acuity
After removal of a pituitary tumour what condition can arise?
Panhypopituitarism
