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Neurology > Brain Tumours > Flashcards

Brain Tumours Flashcards

1
Q

How do brain tumours commonly present?

A
  • Progressive neurological deficit
  • Motor weakness
  • Headache
  • Seizures
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2
Q

What are the signs of increased intracranial pressure?

A

Headaches, vomiting, mental changes, seizures

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3
Q

State the key red flag for brain tumours

A

Headache that wakes you up at night, is worse lying down and in the morning, worse with coughing and not relieved by pain killers

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4
Q

Name three types of herniation

A

Subfalcine
Uncal
Tonsillar

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5
Q

What is Cushings Triad and what is it a sign of?

A

Hypertension, bradycardia, irregular respiration

- a sign of impending herniation

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6
Q

What percentage of patients with a brain tumour have papilloedema?

A

<10%

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7
Q

How can you tell the location of a brain tumour?

A

The signs correlate to location in the brain

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8
Q

What does DANISH stand for?

A 
Disdiadochokinesis
Ataxia
Nystagmus 
Intention tremor
Slurred speech 
Hypotonia
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9
Q

State the investigations carried out on a suspected brain tumour

A 
CT/MRI (CT easy to access but MRI gold standard)
Lumbar puncture 
PET scan 
Lesion biopsy 
EEG 
Evoked potentials 
Angiograms 
Radio-nucleotide studies
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10
Q

Name the two main subtypes of glioma

A

Astrocytoma

Oligodendroglioma

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11
Q

How are astrocytomas classified?

A

Grade 1-4

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12
Q

Describe grade 1-4 astrocytomas

A

1 - Mixed glial and neuronal
2 - Low grade
3 - Anaplastic
4 - Glioblastoma

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13
Q

Describe grade 1 astrocytoma

A

Truly benign, slow growing in children/young adults homogeneous and can be cured with surgery

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14
Q

How do astrocytomas present in kids?

A

Ataxia
Tiptoe walking
Vomiting
Headache

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15
Q

What is a rare variant of grade 1 astrocytoma?

A

Pilocytic - involvement of optic nerve, hypothalamic glioma or cerebellum

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16
Q

Name three common sites for a grade 2 astrocytoma

A

Temporal lobe
Posterior frontal lobe
Anterior parietal

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17
Q

Describe grade 2 astrocytoma

A

Pleomorphic with vascular proliferation and necrosis, presents with seizures

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18
Q

State the factors for poor prognosis for a grade 2 astrocytoma

A 
>50years old 
Focal deficit 
Short duration 
Raised ICP 
Enhancement 
Altered consciousness 
Progression to malignant
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19
Q

What is the treatment for grade 2 astrocytoma?

A

Surgery and PCV chemo and radiotherapy

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20
Q

What can happen if the astrocytoma is not treated effectively?

A

It can become a glioblastoma

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21
Q

Name the two malignant astrocytoma

A
  • anaplastic

- glioblastoma

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22
Q

What is the expected survival for anaplastic astrocytoma?

A

2 years

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23
Q

Describe a glioblastoma

A

Most common, can occur as a primary tumour, <1 year survival spreads via white matter/CSF

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24
Q

How can malignant astrocytomas be managed?

A

Surgery - cytoreduction, reduce symptoms
Radiotherapy
TMZ chemo
All in combination give 14 month survival

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25
Q

What is the danger with TMZ chemotherapy?

A

CSF leaks can occur due to placement of chemotherapy

26
Q

What is the age restriction for radiotherapy?

A

3 years old as it drops your IQ by 10

27
Q

How do oligodendrogliomas often present and why?

A

Seizures due to slow growing tumour in frontal lobe

28
Q

In an oligodendroglioma what is the classic appearance of subarachnoid accumulations?

A

Toothpaste morphology

29
Q

What is a collision tumour?

A

Mix of astrocytic and oligodendroglial cells

30
Q

What do oligodendrogliomas look like?

A

Calcified with cysts and peritumoral haemorrhage

31
Q

Are oligodendrogliomas usually benign or malignant?

A

Usually low grade but can have malignant conversion

32
Q

What is the treatment for oligodendrogliomas?

A

Surgery, PCV chemo, radiotherapy

33
Q

What is the survival for oligodendroglioma?

A

10 years

34
Q

Describe meningioma en plaque

A

Carpet like lesion infiltrates the dura and sometimes invades bone

35
Q

Where do meningiomas originate?

A

Arachnoid granulations they are extra-axial

36
Q

Name four common sites of meningioma

A
  • parasagittal
  • convexity
  • sphenoid
  • intraventricular
37
Q

What are the symptoms of meningiomas?

A

Headaches, cranial nerve neuropathies, regional disturbance

38
Q

What percentage of meningiomas are benign?

A

90%

39
Q

What type of cancer can metastasise to the meninges?

A

Breast

40
Q

Name four aggressors

A
  • clear cell
  • chordoid
  • rhabdoid
  • papillary
41
Q

Where will radiation induced tumours arise?

A

Midline (childhood leukaemia)

42
Q

How do meningiomas look on CT?

A

Homogeneous, dense enhancement, oedema and hyperostosis

43
Q

How do meningiomas look on MRI?

A

Dural tail, patency of sinuses

44
Q

What can help with resection of meningiomas?

A

Embolisation of tumour vasculature

45
Q

Define tumour blush

A

Increasing hypervascular arterial phase and slow venous washout

46
Q

How are meningiomas treated?

A

Surgery, radiotherapy but it may just be left

47
Q

How can an acoustic neuroma present?

A

Hearing loss, tinnitus, dysequilibrium, 5th,7th,8th cranial nerve dysfunction, brainstem, hydrocephalus

48
Q

State the buzzword for the appearance of an acoustic neuroma on imaging

A

Ice cream cone

49
Q

How are acoustic neuromas managed?

A

Medically more than surgically - radiosurgery is gold standard

50
Q

Post radiosurgery what are the complications?

A

Facial nerve Palsy
Corneal reflex
Nystagmus
Abnormal ocular movements

51
Q

State the peak incidence for pineal tumours

A

10-12 years old

52
Q

Where can pineal tumours metastasise to?

A

CSF

53
Q

How are geminomas treated?

A

Radiosensitive if >3 years old

54
Q

Name four non-germinatous tumours

A

Yolk sac
Teratoma
Choriocarcinoma
Embryonal carcinoma

55
Q

What tumour markers can be used in pineal tumours?

A

Alpha feto-protein
Beta HCG
LDH

56
Q

If tumour markers are negative what investigation is required?

A

Biopsy

57
Q

What techniques can be used to treat hydrocephalus?

A

Endoscopic Third Ventriculostomy

VP Shunt

58
Q

Name three key signs of pituitary tumour

A
  • endocrine abnormality
  • headache
  • bitemporal hemianopia
59
Q

What investigations are done in suspected pituitary tumour?

A 
Prolactin (cabergoline can treat)
GH/IFG 1 - acromegaly can cause HCOM 
Cortisol - cushings 
TSH, FSH, LH 
Visual fields/acuity
60
Q

After removal of a pituitary tumour what condition can arise?

A

Panhypopituitarism

Neurology (29 decks)

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