Brain Tumours

Question 1

most common extra-axial brain tumour?

Answer 1

meningioma

Question 2

features of meningioma?

Answer 2

benign
arise from residual mesenchymal cells in meninges
cause symptoms by compressing underlying brain

Question 3

other types of extra-axial brain tumour?

Answer 3

pituitary adenoma
craniopharyngioma
choroid plexus tumour
acoustic neuroma

Question 4

most common presenting features of brain tumours in general?

Answer 4

headache
progressive neurological deficit
motor weakness
seizures

Question 5

features of brain tumour headache?

Answer 5

worse in morning
causes waking
worse on coughing, vomiting, leaning forward etc
can be associated with vomiting
can be similar to migraine/tension headache in some cases

Question 6

what causes headache in brain tumour?

Answer 6

raised ICP
invasion/compression of dura, BVs, periosteum
can be 2ndary to diplopia (straining to focus etc)
extreme hypertension (cushings triad in raised ICP)
psychogenic (worrying about symptoms etc)

Question 7

what is cushings triad?

Answer 7

triad of physiological responses to raised ICP

• increased BP
• reduced HR
• reduced RR

Question 8

deficits in frontal lobe tumour?

Answer 8

movement problems
thought and reasoning affected
behaviour changes
memory problems 
perseveration

Question 9

what is perseveration?

Answer 9

the repetition of a particular response (such as a word, phrase, or gesture) regardless of the absence or cessation of a stimulus

Question 10

deficits in perietal lobe tumour?

Answer 10

dyspraxia
sensation problems
neglect
intellect

Question 11

deficits in temporal lobe tumour?

Answer 11

hearing and vision pathways

emotion

Question 12

visual field defect in temporal lobe lesion?

Answer 12

superior quadrantanopia

Question 13

deficits in occipital lobe lesion?

Answer 13

visual field defect
left = speech, motor and sensory function
right = abstract concepts

Question 14

deficits in cerebellar lesion?

Answer 14

DANISH
- dysdiadokinesia
- ataxia
- nystagmus
- intention tremor
- slurred speech (dysarthria)
- hypotonia 
also have problems with balance and coordination

Question 15

investigations in brain tumours?

Answer 15

CT
MRI
lumbar puncture
PET scan
lesion biopsy
EEG
angiogram
radionucleotide studies

Question 16

potential sites for brain tumours?

Answer 16

meninges
neuroepithelial tissue
nerve sheath cells
developmental lesions
germ cells
local extension from adjacent structures
metastases
haematopoietic/lymphomas

Question 17

types of neuroepithalial tissue?

Answer 17

astrocytes - mainly
oligodendrocytes - mainly
ependymal cells/choroid plexus
neuronal cells
embryonic
pineal cells

Question 18

astrocyte and oligodendrocyte derived tumours are known as what?

Answer 18

glial tumours

Question 19

grade 1 astrocytic tumour?

Answer 19

pilocytic astrocytoma/pleomorphic xanthoastrocytoma
benign and slow growing (cannot become malignant)
common in children and young adults
can occur in optic nerve, hypothalamus, cerebellum, brainstem

Question 20

grade 1 astrocytic tumour management?

Answer 20

surgery (usually curative)

Question 21

grade 2 astrocytic tumour?

Answer 21

low grade astrocytoma
can be fibrillary, gemistocytic or protoplasmic
can become malignant if left
often presents with seizures

Question 22

pathology features of grade 2 astrocytic tumour?

Answer 22

hypercellular
pleomorphism
vascular proliferation
necrosis

Question 23

how is grade 2 astrocytic tumour managed>

Answer 23

surgery +/- chemotherapy, radiotherapy or both

Question 24

grade 3 astrocytic tumour?

Answer 24

anaplastic astrocytoma

can arise de novo

Question 25

median survival of grade 3 astrocytic tumour (anaplastic astrocytoma)?

Answer 25

2 years

Question 26

management of grade 3 astrocytic tumour?

Answer 26

surgery + post op external beam radiotherapy

not curative but gives cytoreduction and reduces mass effect

Question 27

grade 4 astrocytic tumour?

Answer 27

glioblastoma multiforme
(most common primary brain tumour)
spreads via white matter tracts and CSF pathways
can have multiple gliomas

Question 28

median survival of glioblastoma multiforme?

Answer 28

<1 year

Question 29

how many glial tumours are derived from oligodendrocytes?

Answer 29

20%

Question 30

where do oligodendroglial tumours often arise?

Answer 30

usually in frontal lobe

Question 31

how do oligodendroglial tumours present?

Answer 31

usually 25-45 year olds

presents with seizures often

Question 32

how can oligodendroglial tumours be differentiated from astrocytomas?

Answer 32

calcification (usually peripheral)
cysts
peritumoral haemorrhage

Question 33

other pathology features of oligodendroglial tumours?

Answer 33

solid and grey/pink on cut surface
toothpaste morphology
mucinous change

Question 34

how are oligodendroglial tumours managed?

Answer 34

chemotherapy
surgery + chemo
radiotherapy can reduce seizures
PVC chemo + radiotherapy = doubled survival

Question 35

median survival of oligodendroglial tumours?

Answer 35

10 years

Question 36

where do meningiomas derive from?

Answer 36

arachnoid cap cells

extra-axial

Question 37

what are meningiomas associated with?

Answer 37

breast cancer

NF2

Question 38

where can meningiomas occur?

Answer 38

parasagittal
convexity
sphenoid
intraventricular

Question 39

how do meningiomas present?

Answer 39

usually asymptomatic
can have headaches
can cause cranial nerve neuropathies if in skull base