Brain Tumours (Clinical)

Question 1

what are the CNS tumours?

Answer 1

Tumours of neuroepitheal tissue
  Tumours of meninges
  Tumours of cranial and spinal nerves
  Haematopoietic neoplasms
  Germ cell tumours
  Cysts and tumour-like lesions
  Tumours of the sellar region
  Local extensions from regional tumours
  Metastatic tumours

Question 2

what are the primary types of brain tumour?

Answer 2

neuroepitheal tissue
glioma (glioblastoma multiforme)
meninges
meningioma
pituitary
adenoma

Question 3

what are the secondary types of brain tumour?

Answer 3

Commonest tumours that spread to the brain are:
renal cell carcinoma
lung carcinoma
breast carcinoma
malignant melanoma
GI tract

Question 4

what are gliomas?

Answer 4

Gliomas are derived from astrocytes

structural and nutritional support to nerve cells

Question 5

what are the characteristics of meningiomas?

Answer 5

slow growing
extra-axial
usually benign
arise from arachnoid
frequently occur along 
	falx, convexity, or sphenoid bone
usually cured if completely removed

Question 6

what is the most common pituitary tumours?

Answer 6

Adenoma

Question 7

whats the presentation of pituitary tumours?

Answer 7

visual disturbance
compression of optic chiasm
hormone imbalance

Question 8

what is the clinical presentation of pituitary tumours?

Answer 8

raised intracranial pressure
(mass effect)

focal neurological deficit

epileptic fits

CSF obstruction

Question 9

what are the raised ICP symptoms?

Answer 9

headache  (typically morning headache)
nausea / vomiting
visual disturbance  (diplopia, blurred vision)
somnolence
cognitive impairment
altered consciousness

Question 10

what are the raised ICP signs?

Answer 10

papilloedema
6th nerve palsy
cognitive impairment
altered consciousness
3rd nerve palsy

Question 11

what is hydrocephalus?

Answer 11

CSF production 400 - 450 cc / day

Question 12

investigation of hydrocephalus?

Answer 12

CT scan
MRI scan
biopsy

Question 13

characteristics of a focal neurological deficit

Answer 13

hemiparesis
dysphasia
hemianopia
cognitive impairment 
	(memory, sense of direction)
cranial nerve palsy
endocrine disorders

Question 14

characteristics of epilepsy

Answer 14

only in lesions above tentorium
first fit - 20% chance of tumour
draws attention to possibility of tumour
indicates location of tumour

Question 15

what are the management goals?

Answer 15

– accurate tissue diagnosis
– improve quality of life
decreasing mass effect/
improve neurological deficit
– aid effect of adjuvant therapy 
	(if required)
– prolong life expectancy

Question 16

what are the management options?

Answer 16

Glioblastoma multiforme
complete surgical excision impossible
biopsy or debulk only
medical
Steroids
anticonvulsants
radiotherapy
chemotherapy
temazolamide

Metastasis - most important to confirm diagnosis
11% with abnormal cerebral imaging and a history of cancer, do not have cerebral mets.
medical
steroids, anticonvulsants
radiotherapy
whole brain, steriotatic
surgery

Question 17

why not do a lumbar puncture?

Answer 17

You might cause meningitis
You might cause a herniation syndrome and the patient could die
You might cause an air embolism
You might make the patient’s headache worse