Brain tumours Flashcards
Three examples of primary tumours
Neuroepithelial tissue - glioma (glioblastoma multiforme)
Meninges - meningioma
Pituitary - adenoma
Brain tumours commonly occur seconday to…
Renal cell carcinoma Lung Breast Malignant melanoma GI tract
Metastases
15-30%
9% cerebral metastasis only detectable site of spread
Increasing incidence
Gliomas
Derived from astrocytes - structural and nutritional support to nerve cells
WHO Grade I-IV
Which part of the brain mater do meningiomas arise from?
Arachnoid
Where do meningiomas occur?
Along the flax, convexitty or sphenoid bone
Which pituitary tumour is most common?
Adenoma
What signs and symptoms occur in pituitary tumours?
Visual disturbance - compression of optic chiasm
Hormone imbalance
Which structure will pituitary tumours compress?
Optic chiasm
Clinical presentation of patient with brain tumour
Raised ICP
Focal neurological deficit
Epileptic fits
CSF obstruction
Symptoms of raised ICP
Headache (morning) Nausea and vomiting Visual disturbance Somnolence (sleepy/drowsy) Cognitive impairment Altered consciousness
Signs of raised ICP
Papilloedema 6th nerve palsy Cognitive impairment Altered consciousness 3rd nerve palsy
When does hydrocephalus typically occur?
With tumours close to CSF pathways
Posterior fossa tumours
Children
Diagnosis of hydrocephalus
History and exam CXR for source of primary tumour CT MRI Biopsy Retinal photograph - papilloedema
Examples of focal neurological deficit
Hemiparesis Dyshpagia Hemianopia Cognitive impairment (memory, direction) Cranial nerve palsy Endocrine disorders
Diagnostic test for cerebellar lesion
MRI
What is Gerstmann’s syndrome?
Loss of 4 cognitive abilities due to lesion
- Acalculia - Arithmetic
- Agraphia, Dysgraphia
- Finger agnosia - can’t recognise, indicate fingers
- Cannot distinguish right and left
Management of Gerstmann’s syndrome
Investigative imaging - MRI
Surgery to alleviate causative issue eg partietal lobe lesions
Address developmental issues - education, rehabilitation, counselling
Focal or generalised seziures (epilepsy) will only occur if lesions are above which area?
Above the tentorium
Investigations indicated if ?metastasis
CT MRI PET CT chest/abdo/pelvis Mammography Biopsy skin lesions/lymph nodes
Principle treatment in SOL
Corticosteroids (dexamethasone) Treat epilepsy Analgesics/antiemetics Counselling Surgery Radiotherapy Chemotherapy Endocrine replacement
Management for glioblastoma
Surgical excision - biopsy or debulk
Medical - steroids, anticonvulsants
Radiotherapy
Chemotherapy - Temazolamide
Management of metastasis to brain
Medical
Radiotherapy - whole brain or stereotactic
Surgery
Management of meningioma
Common;y cured by surgery
May require anticonvulsants
Prognosis for astrocytomas
Low grade - long life expectancy
High grade or GBM – average 1 year survival
Should lumbar puncture be perfromed where signs of intracranial mass lesion are present?
NO
Leads to meningitis, herniation syndrome, air embolism, worsen headache
Complications of lumbar puncture
Meningitis
Air embolism
Herniation syndrome
Worsen headache
What is the Monro Kellie Doctrine?
Three components of tissue, blood and CSF exist in equilibrium to maintain fixed volume and ICP
Space occupying lesions can disrupt the ICP leading to??
Herniation
What is the function of the falx cerebri and tentorium cerebelli?
Fibrous sheets preventing excessive movement
Examples of space occupying lesions
Blood
Tumour
Abscess
Most concerning herniation
Uncal
Cerebellotonsillar
What structure is impacted in an uncal herniation?
Aqueduct crushed and narrowed - flow of CSF
Subfalcine herniation causes what visible change?
Midline shift
Swelling and shift of tissue due to SOL causes what zone around the tumour?
Ischaemic zone
Morning headaches and sickness occur due to which change in tissue in case of SOL?
Squeeze on cortex and brainstem
Papilloedema is caused by increased pressure where?
On optic nerve
3 signs of ICP increase
Pupillary dilation - strectching CN III
- Falling GCS
- Brain stem death
Name tumours of nerve sheath cells
Schwannoma, neurofibroma
Where do CNS tumours commonly occur in adults?
Above tentorium
Where do CNS tumours commonly occur in children?
Below tentorium
Nerve sheath tumour causing unilateral deafness
Vestibulocochlear nerve CN VIII schwannoma
Benign
