Brain tumours (clinical) Flashcards
INTRO: name some common types of brain tumours
primary benign
- menangioma
- pituitary adenoma
primary malignant
- glioma (GBM)
secondary metastases
- renal, lung, melanoma, breast, GI tract
give some of the WHO classifications of CNS tumours
tumours of: neuroepithelial tissue meninges cranial/spinal nerves germ cells cysts/lesions mets
what are the commonest types of primary brain tumours
glioma (GBM) - neuroepithelial tissue
meningioma - meninges
adenoma - pituitary
what are the commonest tumours that result in secondary brain mets
renal cell carcinoma lung carcinoma breast carcinoma malignant melanoma GI tract
what is the most common brain tumour seen clinically
secondary mets
what are some characteristics and spread of gliomas
derived from astrocytes
- structural and nutritional support to nerve cells
Glioblastoma multiforme
= WHO grade IV
- most common
- most aggressive
spread by tracking through white mater and CSF pathway
rarely spread systemically
what are the characteristics of meningiomas
slow growing
extra-axial
usually benign
arise from arachnoid
frequently occur along falx, convexity, or sphenoid bone
usually cured if completely removed
how do pituitary tumours present
most commonly adenoma
visual disturbance - compression of the optic chiasma
hormone imbalance
what is the clinical presentation of brain tumours
raised ICP - mass effect
focal neurological deficit
epileptic fits
CSF obstruction
what are the symptoms of raised ICP
headache (typically morning headache)
nausea / vomiting
visual disturbance (diplopia, blurred vision)
somnolence
cognitive impairment
altered consciousness
what are the signs of raised ICP
papilloedema 6th nerve palsy 3rd nerve palsy cognitive impairment altered consciousness
what tumours can cause hydrocephalus
in or close to CSF pathway
especially posterior fossa tumours
especially in children
how can a brain tumour be diagnosed
history and examination
Chest xray - possible sources of secondary tumours
CT
MRI
biopsy
give some examples of focal neurological deficits that can be caused by brain tumours
hemi-paresis dysphasia hemianopia cognitive impairment (memory, sense of direction) cranial nerve palsy endocrine disorders
CASE 1: A 66 year old, left handed, woman presents with ataxia and in-coordination.
Where would you suspect
her lesion to be?
Cerebellar lesion
lack of voluntary motor control + incoordination
CASE 2: A 44 year old, right handed, woman presents with acalculia, agraphia,
finger agnosia and right/left confusion.
Where would you suspect
her lesion to be?
left (HER DOMINANT) parietal lobe
Gerstmanns syndrome
- acalculia
- agraphia
- finger agnosia
CASE 3: A 30 year old, right handed, man presents with a bi temporal hemianopia.
Where would you suspect
his lesion to be?
pituitary
pressing on optic chisma = bi temporal hemianopia
CASE 4: A 50 year old right handed man presented to medical team with cognitive language dysfunction:
- difficulty reading e-mails
- difficulty expressing what he wished to say
- short-term memory impairment
Where do you think the lesion is?
left temporo-parietal area
what are the two types of epilepsy
focal
generalised
how does epilepsy occur in brain tumours
only in lesions above the tentorium
first fit = 20% chance of tumour
indicates location of tumours
what investigations can be done to diagnose brain tumours
cerebral imagine
- CT, MRI, PET, angiography
if suspected metastasis
- CT chest/abdo/pelvis
- mammography
- biopsy skin lesions/lymph nodes
what are the goals of brain tumour management
accurate tissue diagnosis
improve quality of life
- decreasing mass effect
- improve neurological deficit
aid effect of adjuvant therapy
prolong life expectancy
what are the main treatments for brain tumours
corticosteroids (Dexamethasone)
treat epilepsy (anticonvulsant drugs)
analgesics / antiemetics
counselling
surgery
radiotherapy/chemotherapy
endocrine replacement
what is the specific treatment for glioblastoma multiform
complete surgical excision impossible = biopsy or debulk only
medical
- Steroids
- anticonvulsants
radiotherapy
chemotherapy
- temazolamide
what is the specific treatment for mets
most important to confirm diagnosis
medical
- steroids
- anticonvulsants
radiotherapy
- whole brain, steriotatic
surgery
what is the specific treatment for meningioma
commonly cured by surgery
may require anticonvulsants
what is the prognosis for meningioma, astrocytomas and mets respectively
meningioma - good
astrocytoma
- low grade - long life
- GBM - 1yr survival
mets - good/medium term remission
CASE 5: 50 year old woman
decreased level of consciousness
4 day history of drowsiness
headache and nauseated
PMH - Nil
No allergies, no medications
Smokes pkt cigarettes/day, minimal alcohol
GSC 11 e3v3m5 Pupils equal and reactive No apparent focal neurological signs Mild pyrexia (37.5°C) Examination normal
What investigations would you do and what ones would you not do? Why?
yes
- CT
- MRI
no
- LP
signs and symptoms suggest an intracranial mass lesion
= raised ICP
why wouldn’t you do a LP in patients with an intracranial mass lesion
raised ICP:
can cause meningitis
can cause a herniation syndrome and the patient could die
can cause an air embolism
might make the patient’s headache worse
SUMMARY: name some common types of brain tumours
primary benign
- menangioma
- pituitary adenoma
primary malignant
- glioma (GBM)
secondary metastases
- renal, lung, melanoma, breast, GI tract
SUMMARY: briefly how do brain tumours present
signs of raised ICP
- headache, nausea/vomiting, papilloedema
seizures
neurological deficit
SUMMARY: what is the management of brain tumours
appropriate investigations ease symptoms aid effect of adjuvant therapy - radiotherapy - chemotherapy prolong life expectancy
