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NEURO > Brain tumours (clinical) > Flashcards

Brain tumours (clinical) Flashcards

1
Q

INTRO: name some common types of brain tumours

A

primary benign

  • menangioma
  • pituitary adenoma

primary malignant
- glioma (GBM)

secondary metastases
- renal, lung, melanoma, breast, GI tract

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2
Q

give some of the WHO classifications of CNS tumours

A 
tumours of:
neuroepithelial tissue 
meninges
cranial/spinal nerves 
germ cells
cysts/lesions
mets
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3
Q

what are the commonest types of primary brain tumours

A

glioma (GBM) - neuroepithelial tissue

meningioma - meninges

adenoma - pituitary

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4
Q

what are the commonest tumours that result in secondary brain mets

A 
renal cell carcinoma
lung carcinoma
breast carcinoma
malignant melanoma 
GI tract
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5
Q

what is the most common brain tumour seen clinically

A

secondary mets

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6
Q

what are some characteristics and spread of gliomas

A

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

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7
Q

what are the characteristics of meningiomas

A

slow growing

extra-axial

usually benign

arise from arachnoid

frequently occur along falx, convexity, or sphenoid bone

usually cured if completely removed

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8
Q

how do pituitary tumours present

A

most commonly adenoma

visual disturbance - compression of the optic chiasma

hormone imbalance

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9
Q

what is the clinical presentation of brain tumours

A

raised ICP - mass effect

focal neurological deficit

epileptic fits

CSF obstruction

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10
Q

what are the symptoms of raised ICP

A

headache (typically morning headache)

nausea / vomiting

visual disturbance (diplopia, blurred vision)

somnolence

cognitive impairment

altered consciousness

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11
Q

what are the signs of raised ICP

A 
papilloedema 
6th nerve palsy 
3rd nerve palsy 
cognitive impairment
altered consciousness
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12
Q

what tumours can cause hydrocephalus

A

in or close to CSF pathway

especially posterior fossa tumours

especially in children

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13
Q

how can a brain tumour be diagnosed

A

history and examination

Chest xray - possible sources of secondary tumours

CT

MRI

biopsy

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14
Q

give some examples of focal neurological deficits that can be caused by brain tumours

A 
hemi-paresis
dysphasia
hemianopia
cognitive impairment (memory, sense of direction)
cranial nerve palsy
endocrine disorders
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15
Q

CASE 1: A 66 year old, left handed, woman presents with ataxia and in-coordination.

Where would you suspect
her lesion to be?

A

Cerebellar lesion

lack of voluntary motor control + incoordination

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16
Q

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?

A

left (HER DOMINANT) parietal lobe

Gerstmanns syndrome

  • acalculia
  • agraphia
  • finger agnosia
17
Q

CASE 3: A 30 year old, right handed, man presents with a bi temporal hemianopia.

Where would you suspect
his lesion to be?

A

pituitary

pressing on optic chisma = bi temporal hemianopia

18
Q

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?

A

left temporo-parietal area

19
Q

what are the two types of epilepsy

A

focal

generalised

20
Q

how does epilepsy occur in brain tumours

A

only in lesions above the tentorium

first fit = 20% chance of tumour

indicates location of tumours

21
Q

what investigations can be done to diagnose brain tumours

A

cerebral imagine
- CT, MRI, PET, angiography

if suspected metastasis

  • CT chest/abdo/pelvis
  • mammography
  • biopsy skin lesions/lymph nodes
22
Q

what are the goals of brain tumour management

A

accurate tissue diagnosis

improve quality of life

  • decreasing mass effect
  • improve neurological deficit

aid effect of adjuvant therapy

prolong life expectancy

23
Q

what are the main treatments for brain tumours

A

corticosteroids (Dexamethasone)

treat epilepsy (anticonvulsant drugs)

analgesics / antiemetics

counselling

surgery

radiotherapy/chemotherapy

endocrine replacement

24
Q

what is the specific treatment for glioblastoma multiform

A

complete surgical excision impossible = biopsy or debulk only

medical

  • Steroids
  • anticonvulsants

radiotherapy

chemotherapy
- temazolamide

25
Q

what is the specific treatment for mets

A

most important to confirm diagnosis

medical

  • steroids
  • anticonvulsants

radiotherapy
- whole brain, steriotatic

surgery

26
Q

what is the specific treatment for meningioma

A

commonly cured by surgery

may require anticonvulsants

27
Q

what is the prognosis for meningioma, astrocytomas and mets respectively

A

meningioma - good

astrocytoma

  • low grade - long life
  • GBM - 1yr survival

mets - good/medium term remission

28
Q

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?

A

yes

  • CT
  • MRI

no
- LP
signs and symptoms suggest an intracranial mass lesion
= raised ICP

29
Q

why wouldn’t you do a LP in patients with an intracranial mass lesion

A

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

30
Q

SUMMARY: name some common types of brain tumours

A

primary benign

  • menangioma
  • pituitary adenoma

primary malignant
- glioma (GBM)

secondary metastases
- renal, lung, melanoma, breast, GI tract

31
Q

SUMMARY: briefly how do brain tumours present

A

signs of raised ICP
- headache, nausea/vomiting, papilloedema

seizures

neurological deficit

32
Q

SUMMARY: what is the management of brain tumours

A 
appropriate investigations
ease symptoms
aid effect of adjuvant therapy
- radiotherapy
- chemotherapy
prolong life expectancy

NEURO (51 decks)

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