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Neurology > Brain Tumours > Flashcards

Brain Tumours Flashcards

1
Q

why are brain tumours not classified according to TNM

A

they don’t spread beyond the CNS

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2
Q

what histological features are used for clasifcation

A

cellularity
pleomorphism
mitotic activity

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3
Q

grade 1 tumour

A

pilocytic astrocytoma

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4
Q

grade 2 tumour

A

diffuse astrocytoma (or grade 2 oligodendroglioma)

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5
Q

grade 3 tumour

A

anaplsatic astrocytoma (or grade 3 oligodendroglioma)

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6
Q

grade 4

A

glioblastoma

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7
Q

most common kind of brain tumour

A

astrocytoma

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8
Q

age group affected by primary glioblastoma

A

elderly - de novo

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9
Q

age group affected by secondary glioblastomas

A

younger - end point from low grade transformation

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10
Q

Genetic markers of brain tumours

A

IDH – astrocytoma and oligodendroglia, not primary glioblastoma
LoH1p/19q – oligodendrogliomas and anaplastic oligodendrogliomas
TP53 ATRX – astrocytoma

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11
Q

common clinical features

A 
progressive neurological deficit
motor weakness
headaches
seizures 
increased ICP
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12
Q

features of headache caused by tumours

A

worse in the morning, exacerbated by coughing, straining or bending downwards

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13
Q

supratentorial tumours cause symptoms from which lobes

A

frontal, parietal, temporal, occipital, sellar region

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14
Q

infratentorial cause symptoms from

A

brain stema nd cerebellum

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15
Q

low grade glioblastomas present in symptoms of which order

A

seizures»ICP»focal deficit

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16
Q

high grade glioblastomas present in symptoms of which order

A

ICP/focal deficit > seizure

shirt history

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17
Q

most common type of brain tumours

A

astrocytomas

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18
Q

how do astrocytomas cause regional effects

A

compression, invasion, destruction of brain parenchyma, arterial and venous hypoxia, competition for nutrients, release of metabolic end products and release and recruitment of cellular mediators

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19
Q

risk factors of astrocytic tumours

A

male, white, neurofibromatosis type 1, tuberous scelrosis, li-fraumeni syndrome, turcots cancer, ionising radiation

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20
Q

histological features of pilocytic (grade 1) astrocytomas

A

childhood, benign behavng, long hair like processes

pilocytic, pleomorphic xanthoastrocytoma, subependymal giant cell

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21
Q

histological features of grade 2

A

well differentiated

nuclear atypia

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22
Q

histological features of grade 3

A

anaplastic
greater nuclear atypia
mitotic activity

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23
Q

histological features of secondary grade 4 glioblastomas

A

extreme nuclear atypia
mitotic activity
necrosis and/or neovascularisation

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24
Q

histological features of primary grade 4 glioblastomas

A

extreme nucelar atypia
mitotic activty
necrosis or neovascularisation

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25
Q

common presenting features of pilocytic grade 1

A 
effects children
progressive headache, wide based gait, difficulty speaking
Persistent/recurrent headache
Balance/co-ordination/walking problems
Persistent/recurrent vomiting
Abnormal eye movements
Blurred or double vison/loss of vision
Behaviour change
Fits or seizures
Abnormal head position 
Tailing of developmental milestones
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26
Q

treatment of grade 1

A

surgical removal

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27
Q

low grade symptomatic development

A

long presymptomatic phase, apparent latency stability (will have slow underlying malignant transformation)

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28
Q

management of low grade gliomas (2)

A

watch and wait

maximal resection +/- radiotherapy (only if incomplete removal and malignant degeneration) and chemotherapy

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29
Q

role of radiotherapy

A

early - after surgery

delayed - wait until progression

30
Q

role of chemotherapy

A

if Ip19q consider sole therapy

31
Q

management of high grade glioma

A

surgery - florescence guided resection
radiotherapy after 4 weeks
+/- temozolomide

32
Q

management of recurrent GBM

A

only 10% re-do surgery
2nd line chemo response rate (<10%)
New agents - anti-VEGF, immune checkpoint inhibitors, vaccine

33
Q

causes of tumour headache

A

raised ICP
invasion/compression of dura, BVs, periosteum
2ry to diplopia (III, IV, VI, INO)
2ry to difficulty focusing
Extreme hypertension (cushings triad of increased ICP)
Psychogenic (stress of loss of functional capacity)
headaches not caused by tumour themselves, brain cells have no nerves

34
Q

Investigtaions for brain tumours

A

MRI best
CT contrast and non contrast if not available
other - LP, PET, leison biopsy, EEG, evoked potentials, angiograms, radionucleotide studies

35
Q

poor prognostic factors for grade 2 astrocytomas

A 
Age > 50
Focal deficit
Short duration of symptoms
Altered consciousness
Raised ICP
Enhancement of contrast studies
36
Q

poor surgical prognosis of grade 2 astrocytomas if

A 
Age > 45
Low performance score
Large tumours(dia>6cm) /crossing midline
Incomplete resection
Will be more aggressive in treatment
37
Q

oligodendroglial tumours pathophysiology

A

chicken wire appearance - finely branching vasculature

perineuronal satellitosis - when invading grey matter oligodendrocytes cluster around neurons

38
Q

histological appearance of oligodendroglial tumours

A

fried egg appearance - enlarged, round nuclei with dark, compact nuclei and small amount of eosinophilic cytoplasm

39
Q

collision tumours

A

oligodendroglal cells coexist woth astrocytic cells in a neoplastic collision tumour, shared common precursor

40
Q

oligodendroglial tumours grading histology

A

grade II fried egg

grade III chicken wire

41
Q

how to differentiate oligodendroglial tumours from astrocytic tumours

A

Biopsy

features include calcification, cysts, peritumoral haemorrhage

42
Q

malignant astrocytomas include

A

anaplastic astrocytomas

glioblastoma multiforme - divide so fast often necrosis in middle

43
Q

management of oligodendrogliomas

A

surgery + chemotherapy (PLC) +/- radiotherapy

44
Q

where do meningiomas arise from

A

arachnoid granulations
often near dural sinuses
are extraaxial - also parasagittal

45
Q

epidemiology factors about meningomas

A

most common benign tumour
more common in female (3:2)
15% or primary tumours

46
Q

meningioma en plaque

A

meningioma may involve bone - produces hyperptosis and mass in regions often producing visible bony growth or proptosis

47
Q

causes of meningiomas

A

previous radiotherapy (especially in childhood)
family history
hormones (prsence of receptors)
link with breast cancer and NF11 (22Q gene?)

48
Q

how are meningiomas classified?

A

by site in cranium - parasagittal, convexity, sphenoid, intraventricular
Also - classic, angioblastic, atypical, malignant

49
Q

aggressors in malignant meningiomas

A

clear cell, choroid, rhabdoid, papillary, radiation induced

50
Q

histology of meningiomas

A

calcified psammoma bodies
multinuclear syntcium of fused cells
whorls of meningothelial and spindle cells

51
Q

clinical features of meningiomas

A

as other tumours
often asymptomatic due to small size
compress rather than invade adjacent brain

52
Q

preoperative evaluation of meningioma

A

CT – homogenous, densely enhancing, oedema, hyperostosis/skull blistering
MRI – dural tail, patency of dural sinuses
Angiography +/- embolization – external carotid artery feeders, occlusion of sagittal sinus

53
Q

management of meningiomas

A

low grade - resection
high grade - resection and radiotherapy
recurrence - depends on grade and extent of resection

54
Q

simpson grading for extent of resection

A

grade I - complete removal including underlying bone and associated dura
grade II - complete removal and coagulation of dural attachment
grade III - complete removal w/o resection of dura or coagulation
grade IV - subtotal resection
grade V - simple decompression with or without biopsy

55
Q

medulloblastomas predominantly occur in what age group

A

children (2nd most common type of tumour)

56
Q

where do medulloblastomas commonly occur

A

midline of the cerebellum, below tentorium cerebellum

forms near 4th ventricle

57
Q

clinical features of medulloblastoma relate to

A

increased ICP

58
Q

medulloblastomas are sensitive to

A

radiotherapy

59
Q

types of nerve sheath tumours

A

schwannomas, neurofibromas, malignant peripheral nerve sheath tumours

60
Q

acoustic neuromas are also known as

A

vestibular schwannomas

61
Q

clinical features of acoustic neuromas relate to which cranial nerves

A

V, VI, VII, VIII

62
Q

clinical features of acoustic neuromas

A 
asymmetrical hearingloss
facial numbness
dizziness
vertifo 
tinnitus
absent corneal reflex
dysequilibrium
63
Q

investigationsof acoustic neuromas

A

audiologic/audopmetry
gadolinium enhanced MRI
CT head
auditory brainstem reflexes

64
Q

management of acoustic neuromas

A

if hearing okay - expectant management (hearing aids)

hydrocephalus management - surgeyr and radiation

65
Q

complications of surgery on acoustic neuromas

A

facial nerve palsy
corneal reflex
nystagmus
abnormal eye movement

66
Q

STUPP Protocol

A

for treatment of glioblastoma

surgical resection, chemotherapy, radiation

67
Q

what is MGMT promotor methylation

A

predicts response to alkylating chemotherapy whereby presence of methylation predicts better survival

68
Q

what symptoms occur with brain tumours in frontal lobe?

A

– Personality dysfunction
– Paraparesis
– Paratonia
– Grasp reflex
– Frontal gait dysfunction (magnetic gait)
– Cortical hand
– Seizures
– Incontinence
– Visual field defects (anterior visual pathway incl optic chiasms are beneath frontal lobe)
– Expressive dysphasia (Broca’s area is in the dominant frontal lobe)
– Anosmia (olfactory pathway is beneath frontal lobes)

69
Q

what symptoms occur with brain tumours in temporal lobe?

A
  • Memory dysfunction especially episodic memory
  • Agnosia (visual and sensory modalities in particular)
  • Language disorders eceptive dysphasia (Wernicke, dominant hemisphere)
  • Visual field defects (congruous upper homonymous quadrantanopia)
  • Auditory dysfunction (Heschel’s gyrus, as hearing is represented bilaterally, deafness is not a cerebral feature)
  • Limbic dysfunction
  • Temporal lobe epilepsy
70
Q

what symptoms occur with brain tumours in parietal lobe?

A
  • Visual field defect (congruous lower homonymous quadrantanopia)
  • Sensory dysfunction (visual and sensory modalities in particular)
  • Gerstmann’s syndrome (disease of the dominant angular gyrus, part of the inferior parietal lobe): Dysgraphia, left-right disorientation, finger agnosia, acalculia
  • Dyspraxia
  • Inattention (non-dominant angular gyrus)
  • Denial

Neurology (18 decks)

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