Brain Tumours Flashcards
most common extra-axial brain tumour?
meningioma
features of meningioma?
benign
arise from residual mesenchymal cells in meninges
cause symptoms by compressing underlying brain
other types of extra-axial brain tumour?
pituitary adenoma
craniopharyngioma
choroid plexus tumour
acoustic neuroma
most common presenting features of brain tumours in general?
headache
progressive neurological deficit
motor weakness
seizures
features of brain tumour headache?
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
what causes headache in brain tumour?
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)
what is cushings triad?
triad of physiological responses to raised ICP
- increased BP
- reduced HR
- reduced RR
deficits in frontal lobe tumour?
movement problems thought and reasoning affected behaviour changes memory problems perseveration
what is perseveration?
the repetition of a particular response (such as a word, phrase, or gesture) regardless of the absence or cessation of a stimulus
deficits in perietal lobe tumour?
dyspraxia
sensation problems
neglect
intellect
deficits in temporal lobe tumour?
hearing and vision pathways
emotion
visual field defect in temporal lobe lesion?
superior quadrantanopia
deficits in occipital lobe lesion?
visual field defect
left = speech, motor and sensory function
right = abstract concepts
deficits in cerebellar lesion?
DANISH - dysdiadokinesia - ataxia - nystagmus - intention tremor - slurred speech (dysarthria) - hypotonia also have problems with balance and coordination
investigations in brain tumours?
CT MRI lumbar puncture PET scan lesion biopsy EEG angiogram radionucleotide studies
potential sites for brain tumours?
meninges neuroepithelial tissue nerve sheath cells developmental lesions germ cells local extension from adjacent structures metastases haematopoietic/lymphomas
types of neuroepithalial tissue?
astrocytes - mainly oligodendrocytes - mainly ependymal cells/choroid plexus neuronal cells embryonic pineal cells
astrocyte and oligodendrocyte derived tumours are known as what?
glial tumours
grade 1 astrocytic tumour?
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
grade 1 astrocytic tumour management?
surgery (usually curative)
grade 2 astrocytic tumour?
low grade astrocytoma
can be fibrillary, gemistocytic or protoplasmic
can become malignant if left
often presents with seizures
pathology features of grade 2 astrocytic tumour?
hypercellular
pleomorphism
vascular proliferation
necrosis
how is grade 2 astrocytic tumour managed>
surgery +/- chemotherapy, radiotherapy or both
grade 3 astrocytic tumour?
anaplastic astrocytoma
can arise de novo
median survival of grade 3 astrocytic tumour (anaplastic astrocytoma)?
2 years
management of grade 3 astrocytic tumour?
surgery + post op external beam radiotherapy
not curative but gives cytoreduction and reduces mass effect
grade 4 astrocytic tumour?
glioblastoma multiforme
(most common primary brain tumour)
spreads via white matter tracts and CSF pathways
can have multiple gliomas
median survival of glioblastoma multiforme?
<1 year
how many glial tumours are derived from oligodendrocytes?
20%
where do oligodendroglial tumours often arise?
usually in frontal lobe
how do oligodendroglial tumours present?
usually 25-45 year olds
presents with seizures often
how can oligodendroglial tumours be differentiated from astrocytomas?
calcification (usually peripheral)
cysts
peritumoral haemorrhage
other pathology features of oligodendroglial tumours?
solid and grey/pink on cut surface
toothpaste morphology
mucinous change
how are oligodendroglial tumours managed?
chemotherapy
surgery + chemo
radiotherapy can reduce seizures
PVC chemo + radiotherapy = doubled survival
median survival of oligodendroglial tumours?
10 years
where do meningiomas derive from?
arachnoid cap cells
extra-axial
what are meningiomas associated with?
breast cancer
NF2
where can meningiomas occur?
parasagittal
convexity
sphenoid
intraventricular
how do meningiomas present?
usually asymptomatic
can have headaches
can cause cranial nerve neuropathies if in skull base
