Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

MD2 Foundation > Brain Tumours and Raised Intracranial Pressure > Flashcards

Brain Tumours and Raised Intracranial Pressure Flashcards

1
Q

When do the peaks in brain tumours occur during life?

A

Infancy and childhood
- Most are development related tumours
7th decade

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the WHO classification of CNS tumours?

A

Based on presumed cell of origin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the common brain tumours?

A 
Neuroepithelial tumours (gliomas) = 52%
- Astrocytoma = 44%
- Ependymoma
- Oligodendroglioma
- Medulloblastoma
Metastatic tumours = 15%
Meningioma = 15%
Pituitary adenoma
Acoustic neuroma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

How are pituitary adenomas classified based on size?

A

Micro <10 mm

Macro >10 mm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the most common type of pituitary adenoma?

A

Prolactinoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are some symptoms of an acoustic neuroma?

A

Features of vertigo that may have a central cause
Nystagmus
CN VI and/or CN VII palsy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Why can an acoustic neuroma cause a CN VI and/or CN VII palsy?

A

Growth of Schwann cells on CN VIII can compress other 2 nerves, which are very close by

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is the aetiology of brain tumours?

A

Few clearly defined environmental risk factors
- Ionising radiation in therapeutic radiotherapy/nuclear explosions increase risk for meningioma and glioma
- No role proven for EM radiation/other environmental factors
Family history rare
Some inherited/genetic conditions predisposing
- Neurofibromatosis 1 and 2
- Li Fraumeni syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Why is a sixth cranial nerve palsy a false lateralising sign?

A

It can occur with raised intracranial pressure (ICP) because of its long route

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is a sensitive test for pyramidal problems?

A

Pronator drift

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is Foster-Kennedy syndrome?

A

Brain tumour on one side of the brain causes optic nerve atrophy on ipsilateral side an papillary oedema on contralateral side due to raised ICP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are the differential diagnoses for raised intracranial pressure with focal neurological deficits suggesting intracranial mass enlarging over a few weeks?

A 
Primary brain tumour
Metastatic brain tumour
Brain abscess
- Possible to have no fever
- More likely if fever present
Chronic subdural haematoma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

When do malignant astrocytomas most commonly occur?

A

6th-8th decade

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the prognosis for malignant astrocytomas?

A

Dismal

Medial survival for glioblastoma multiforme = 7-14 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What defines a malignant astrocytoma histopathologically?

A 
Hypercellularity
Cellular atypia/pleiomorphism
Mitoses
Endothelial hyperplasia
Necrosis/pallisading necrosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is the typical presentation of an intracranial mass?

A 
Symptoms of raised intracranial pressure
Seizures in 40-80%
Focal neurological deficit
- Depends on location of mass
Duration of symptoms depends on rate of growth of mass
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What does the growth rate of a tumour depend on?

A

Grade of tumour

From weeks to years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are the things you see on a CT scan with raised intracranial pressure caused by a mass?

A

Tumour mass
Surrounding oedema
Hydrocephalus if CSF pathways blocked

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are the symptoms of raised intracranial pressure?

A

Headache
Nausea and vomiting
Drowsiness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Describe the headache presentation in raised intracranial pressure

A

Very common symptom in patients with brain tumours
Gradually progressive
Worse on waking > improves during day
Nausea and vomiting as intracranial pressure rises
- Vomiting may relieve headache temporarily

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What does drowsiness indicate in raised intracranial pressure?

A

Important sign of critically raised intracranial pressure
Implies impending deterioration
An alert patient with severely raised intracranial pressure may deteriorate very quickly with even a small further rise

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What does the clinical syndrome of raised intracranial pressure warrant?

A

Urgent investigation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is the Monro-Kellie doctrine?

A

Cranial cavity rigid box - increase in contents > rise in pressure
Some capacity for compensation
When critical point reached, even small increases in volume result in large increases in intracranial pressure

24
Q

What are some focal neurological deficits seen when the tumour is in the frontal lobe?

A

Mood disturbance
Personality change
Psychiatric symptoms
Especially seen in butterfly gliomas, where tumour in both frontal lobes

25
Q

Where is the tumour if there is limb weakness?

A

Motor cortex in posterior frontal lobe

Deep pyramidal pathways

26
Q

Where is the tumour if there is a visual field deficit?

A

Anywhere along visual pathway

  • Occipital
  • Temporal
  • Parietal
27
Q

Where is the tumour if dysphasia is present?

A

Dominant frontal lobe

Temporal lobe

28
Q

What sort of deficits can be caused with brainstem tumours?

A 
Multiple
Weakness
Sensory loss
Diplopia
Cranial nerve deficits
29
Q

What are the principles of treatment of malignant astrocytomas?

A

Steroids = dexamethasone
- Reduction of vasogenic cerebral oedema and intracranial pressure
Resection of as much of tumour as safely possible
Adjuvant therapy
- Radiotherapy and chemotherapy

30
Q

What does surgery for a malignant astrocytoma involve?

A 
Tissue diagnosis essential
Resection of all visible tumour if possible
- Still leave microscopic tumour
- Reduces mass effect and symptoms
- Tissue for banking and research
31
Q

Why is tumour resection often not possible?

A 
Tumour extent
- Large
- Diffuse
Tumour location
Patient age/fitness for surgery
32
Q

What is the prognosis for anaplastic astrocytoma?

A

2-5 years

33
Q

When is prognosis worse in the cases of malignant astrocytoma?

A

Older age at diagnosis, especially >65
Poor neurological condition
Higher grade
Incomplete surgical removal

34
Q

What is the histopathology of a low grade glioma?

A 
Like malignant astrocytoma, but less abnormal for
- Hyper-cellularity
- Cellular atypia/pleiomorphism
- Nuclear atypia/pleiomorphism
Very few mitoses
No necrosis
Invades diffusely through normal brain
May have calcifications
35
Q

What sorts of tumours are included in low grade gliomas?

A

Oligodendroglioma
Astrocytomas
Mixed forms

36
Q

Who is most commonly affected by low grade gliomas?

A

Young = 25-40

37
Q

How do low grade gliomas often present?

A

Neurologically intact

Often only have seizures

38
Q

What is the prognosis for low grade gliomas?

A

Prolonged = years-decades

Eventual growth of low grade tumour/progression to higher grade will occur

39
Q

What are the principles of treatment of low grade glioma?

A

Side effects of treatment important and should be avoided
Removal of as much tumour as safely possible
Often only biopsy taken to avoid deficit
Tissue diagnosis essential
Defer radiotherapy and chemotherapy until tumour progression

40
Q

What is the proportion of solitary to multiple metastatic brain tumours?

A 
Solitary = 1/3
Multiple = 2/3
41
Q

What is the cause of symptoms with metastatic brain tumours?

A

Often cause intense cerebral oedema that causes more symptoms than tumour mass

42
Q

What are the commonest primary tumours to cause brain metastases?

A 
Carcinoma of lung
Carcinoma of breast
Metastatic melanoma
Carcinoma of kidney
Gastrointestinal carcinoma
Unknown primary
43
Q

What is the presentation of metastatic brain tumours?

A

Similar to any mass

  • Raised intracranial pressure
  • Focal deficits
  • Seizures
44
Q

What is the treatment of brain metastases?

A

Steroids = dexamethasone
Surgery to remove metastasis if
- Solitary
- Primary disease stable and patient has reasonable life expectancy
If primary cancer unknown, metastasis removed to confirm diagnosis
Occasionally 1 of multiple metastases removed for palliation
Whole brain radiotherapy
Stereotactic radiotherapy

45
Q

When is whole brain radiotherapy used in brain metastases?

A

Multiple metastases

After removal of single metastasis

46
Q

When is stereotactic radiotherapy used in brain metastases?

A

Single high dose focused radiation for 1-3 metastases

47
Q

How can large meningiomas be asymptomatic?

A

Slow growing so brain has more time to adjust

Not destroying neurons

48
Q

What is the most common benign brain tumour?

A

Meningioma

49
Q

When are meningiomas most likely to occur?

A

Middle age

50
Q

Do meningiomas affect men and women equally?

A

No, more common in women than men

51
Q

What is the cell of origin of meningiomas?

A

Arachnoid cells in meninges

52
Q

What are the characteristic locations of meningiomas?

A

Most common

  • Falx
  • Convexity
  • Sphenoid wing
53
Q

What is the histopathology of meningiomas?

A 
Multiple subtypes
- Generally have no prognostic significance
- Few portend poorer prognosis
Whorls common features
Malignancy infrequent
54
Q

What is the presentation of meningiomas?

A

As for any intracranial mass
- Raised intracranial pressure
- Seizures
- Focal neurological deficit
Slow growing, therefore can reach very large size
- Symptoms may be present for years
- May be symptomatic and discovered incidentally

55
Q

What are the principles of treatment of meningiomas?

A

Total surgical excision and obliteration of dural attachment most effective
Subtotal excision and diathermy of dural attachment if complete excision not possible
Radiosurgery/radiotheray for small, residual, recurrent, or malignant tumours
Extent of resection related to risk of recurrence

MD2 Foundation (42 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions