Brain tumours clinical

Question 1

Examples of primary tumours

Answer 1

Glioma in neuroepithelium
Adenoma in pituitary
Meningioma in the meninges

Question 2

Examples of secondary tumours

Answer 2

Renal carcinoma
GI tract 
Breast carcinoma 
Lung carcinoma
Malignant melanoma

Question 3

which are the most common type of brain tumours seen?

Answer 3

Cerebral metastases are the most common kind of brain tumour seen.

Question 4

What is a Glioma

Answer 4

Tumour of the astrocytes

Question 5

Characters of a glioma

Answer 5

• Graded by WHO on a scale of 1-4
• Type 4 is the most common

Grade 4 is the most common type of GBM to present

• very aggressive
• Dont usually spread systemically

Question 6

How do you investigate for a glioma

Answer 6

-Investigation via tracking White mater and CSF pathway

Question 7

Properties of a meningioma

Answer 7

• Slow growing
• Usually benign
• Can be completely cured if completely removed
• From arachnoid

Question 8

Where does a meningioma usually present

Answer 8

Usually occur along the falx, convexity and sphenoid bone

Question 9

Management of a glioma

Answer 9

-Complete excision is impossible
-Medicines:
Steroids
Anticonvulsants
-Radiotherapy
-Chemotherapy

Question 10

Properties of an adenoma

Answer 10

• Only 1% are malignant
• Usually alter vision due to compression on optic chasm
• Can lead to hormone imbalance due to compression on pituitary

Question 11

Clinical presentation of a tumour

Answer 11

Raised ICP
CSF obstruction
Epileptic seizures
Focal neurological symptoms

Question 12

Symptoms associated with raised ICP

Answer 12

Headache
Nausea 
Cognitive impairment 
Somnolence 
Visual disturbance

Question 13

Signs associated with raised ICP

Answer 13

3rd/6th nerve palsy
Impaired cognitive behaviour
Altered consciousness
Papilloedema

Question 14

Focal neurological defects in brain tumours

Answer 14

Dysphagia
Hemianopia 
Hemiparesia: weakening of one side of the body 
Cognitive impairment 
Cranial nerve palsy 
Endocrine disorder

Question 15

How to investigate a brain tumour

Answer 15

History and examination 
CT
MRI 
Biopsy 
Look for secondary cause of tumour ( imaging and investigations for that)

Question 16

What are the goals of brain tumour management

Answer 16

• Improve quality of life
• Aid adjuvant therapy
• Prolong life expectancy

Question 17

What principles is brain tumour management based on?

Answer 17

• Corticosteroid
• Treat epilepsy (anticonvulsants)
• Analgesia
• Counselling
• Surgery
• Radiotherapy
• chemotherapy
• Endocrine replacement e.g for tumours of the the pituitary gland

Question 18

Prognosis for different types of brain tumour

Answer 18

Meningiomas- usually very good 
Astrocytoma:
Low grade: long life 
High grade/SGB: 1 year life expectancy 
Metastases: remission