Brain Tumours (clinical) Flashcards by Callum Anderson

What are the common metestatic sites for spread to the brain?

Lung

Breast

Kidney

(previous lecture also included melanoma)

How well did you know this?

Not at all

Perfectly

How do we classify brain tumours?

Tissue of origin

ocation

Primary or secondary

Grading

How well did you know this?

Not at all

Perfectly

What percentage of cancer patients develop brain mets?

10-15%

How well did you know this?

Not at all

Perfectly

What are the two most likely causes of neurological death?

Stroke
Brain tumour

How well did you know this?

Not at all

Perfectly

How do we grade tumours?

Microscopic appearence

Growth rate

To grade differentiation:

oGX Grade cannot be assessed (Undetermined)

oG1 Well-differentiated (Low grade)

oG2 Moderately differentiated (Intermediate grade)

oG3 Poorly differentiated (High grade)

oG4 Undifferentiated (High grade)

How well did you know this?

Not at all

Perfectly

What are the common presentations of brain tumour?

Neurological defecit: 68%

45% motor weakness
Mental status changes

HA 54%

Seizures 26%

How well did you know this?

Not at all

Perfectly

What are the genereal signs and symptoms of brain tumours?

oCerebral edema

oIncreased intracranial pressure

oFocal neurologic deficits

oObstruction of flow of CSF

oPituitary dysfunction

oPapilledema (if swelling around optic disk)

How well did you know this?

Not at all

Perfectly

What are the signs and symptoms of cerebral tumours?

oHeadache

oVomiting unrelated to food intake

oChanges in visual fields and acuity

oHemiparesis or hemiplegia

oHypokinesia

oDecreased tactile discrimination

oSeizures

oChanges in personality or behavior

How well did you know this?

Not at all

Perfectly

What are the signs and symptoms for brainstem tumours?

oHearing loss (acoustic neuroma)

oFacial pain and weakness

oDysphagia, decreased gag reflex

oNystagmus

oHoarseness

oAtaxia (loss of muscle coordination) and dysarthria (speech muscle disorder) (cerebellar tumours)

How well did you know this?

Not at all

Perfectly

What are the signs and symptoms of cerebellar tumours?

Disturbances in coordination and equilibrium

How well did you know this?

Not at all

Perfectly

What are the signs and symptoms of pituitary tumours?

Endocrine dysfunction

Visual defecits

Headache

How well did you know this?

Not at all

Perfectly

What are the signs and symptsoms of frontal lobe tumours?

oInappropriate behavior

oPersonality changes

oInability to concentrate

oImpaired judgment

oMemory loss

oHeadache

oExpressive aphasia

oMotor dysfunctions

How well did you know this?

Not at all

Perfectly

What are the signs and symptoms of parietal lobe tumour?

Sensory defecits:

Paresthesia
Loss of 2 point discrimination
Visual field defecits

How well did you know this?

Not at all

Perfectly

What are the signs and symptoms for temporal lobe tumours?

oPsychomotor seizures – temporal lobe-judgment, behavior, hallucinations, visceral symptoms, no convulsions, but loss of consciousness

How well did you know this?

Not at all

Perfectly

What are the signs and symptoms of ocipital lobe tumours?

Visual disturbances

How well did you know this?

Not at all

Perfectly

What is the name given to grade a) 1 and 2 b) 3 c) grade 4

Gliomas?

Grade 1 and 2 glioma - astrocytoma

Grade 3 - anaplastic astrocytoma

Grade 4 - Glioblastoma multiforme (also known as a glioblastoma)

How well did you know this?

Not at all

Perfectly

What are the intraaxial tuomurs?

•Gliomas

oAstrocytoma (Grades I & II)

oAnaplastic Astrocytoma(III)

oGlioblastoma Multiforme(IV)

Oligodendroglioma
Ependymomas
Medulloblastoma
CNS Lymphoma

How well did you know this?

Not at all

Perfectly

What are the extraaxial tumours?

Meningioma
Metastatic
Acoustic neuromas (Schwannoma)
Pituitary adenoma
Neurofibroma

How well did you know this?

Not at all

Perfectly

What are the most common brain tumours?

Gliomas
Meningioma

How well did you know this?

Not at all

Perfectly

What age group is most commonly affected by meningiomas?

Usually age 40 - 70

How well did you know this?

Not at all

Perfectly

Is meningioma usually invasive or non-invasive?

Usually non - invasive

How well did you know this?

Not at all

Perfectly

Where are meningiomas usually located?

Parasaggital region

SPhenoid wing

Parasellar region

How well did you know this?

Not at all

Perfectly

What is the presentation of a meningioma?

Asymptomatic

Symptomatic: Focal or generalised seizure or gradually worsening neurological defecit

How well did you know this?

Not at all

Perfectly

What are the features of meningioma on CT?

Cearly demarcated contours

Frequently have areas of calcification

Isodense or hypodense

How well did you know this?

Not at all

Perfectly

WHich demographic is affected by diffuse low grade astrocytomas?

Young adults

Where do you find astrocytoma?

Frontal region Subcortical white matter

What is the presentation of astrocytoma?

Seizures Headache Slowly progressive neurological defecits

What are the findings of diffuse low grade astrocytoma on CT?

Well circumscribed Hypodense or isodense MRI is more sensitive than CT

What is the most common type of brain tumour in adults?

Glioblastoma

Where can glioblastomas arise from?

May arise de novo (from new) or may evolve from a low grade glioma

What does an astrocytoma resemble?

Can look like a butterfly lesion

What is the location of a glioblastoma?

Frontal and temporal lobe Basal ganglia

What is the presentation of a glioblastoma?

Seizures Headache SLowly progressive neurological defecit

What are the findings of high grade astrocytoma on CT?

Hypodense or isodense Central hypodense area of necrosis surrounded by a thick enhancing rim Surrounding oedema

What is the typical appearance of an oligodendroglioma?

Characteristic fried egg appearance Arises from myelin

What is the location of an oligodendroglioma?

FOund superficially in the frontal lobe

What is the presentation of oligodendroglioma?

Seizures most common Headache Slowly progressive neurologic deficits

What are the features of oligodendroglioma on CT?

Well circumscribed Hypodense lesions with heavy calcification Cystic degeneration is common

What are examples of haemorrhagic brain mets?

Melanoma Renal cell Choriocarcinoma

What are the diagnostic procedures of brain tumours?

•Radiological Imaging oComputed Tomography scan (CT scan) with/without contrast oMagnetic Resonance Imaging (MRI) with/without contrast oPlain films oMyelography oPositron Emission Tomography scan (PET scan) * LP/CSF analysis * Pathology

Why would you use a CT and MRI?

CT - Diagnosis of brain tumours MRI - Folow-up of brain tumours

What might a CT scan miss?

May miss small tumours May miss tumours adjacent to the bone such as (pituitary adenomas, clival tumours and vestibular schwannoma) May miss brainstem tumours Low grade astrocytoma

What is a CT more sensitive to than an MRI scan?

More sensitive than MRI for detecting acute haemorrhage, calcification and bony involvement

What are the advantages of MRI over CT?

More sensitive than CT scans Can detect small tumours Provides much greater anatomic detail Especially useful for visualizing skull base, brain stem and posterior fossa tumours

When are steroids used for brain tumour patients?

Pre-operatively

What is surgical treatment for brain tumours?

Resection Biopsy Craniotomy Stereotaxis surgery Transsphenoidal Endoscopic

What are post - op complications?

* Increased ICP * Hematoma * Hypovolemic shock * Hydrocephalus * Atelectasis - partial collapse or incomplete inflation of the lung * Pulmonary edema * Meningitis * Fluid and electrolyte imbalances (ADH) * Wound infection * Seizures * CSF leak * Edema

How does radiation therapy work?

Damages cells that rapidly divide - sensitive to these cells Usually lasts 4 - 8 weeks

What is a common side effect of radiation therapy?

Skin burn and reddened skin from beam of radiation

How is cerebral oedema controlled before radiation therapy begins?

Corticosteroids are given beforehand

Why might surgery be indicated after radiation therapy?

Radiation necrosis may occur after treatment is completed

Give examples of chemotherapy drugs

How are chemotherapy drugs administered?

PO (means per os in latin - by mouth) IV Intrathecal (spinal injection)

What are the side effects of chemotherapy?

Bone marrow suppression Fatigue Hair loss Nausea / vomitting Anxiety Peripheral neuropathy

What type of tumour causes hydrocephalus due to aqueduct stenosis and also overlies the tectum and midbrain?

Pineal germinoma

What tumour is usually benign Most common in young children?

Low grade pilocytic astrocytomas

What tumour cases locked in syndrome?

Brainstem glioma

Which tumour is most commonly found in the 4th ventricle - median age at diagnosis is also 5?

Ependymoma

Whch tumour has abundant capillary blood vessels?

Haemangioblastoma It is also associated with retinal lesions