Brain Tumours (General)

Question 1

Give an example of an a) intrinsic and b) extrinsic primary brain tumour?

Answer 1

a) Glioma b) Pituitary tumour, meningioma

Question 2

Give examples of where a) supratentorial and b) infratentorial brain tumours would be found?

Answer 2

a) Cerebrum and sella turcica b) cerebellum and brainstem

Question 3

Infratentorial brain tumours are seen most commonly in who? What do they present with?

Answer 3

Children - tiptoeing, ataxia, vomiting and abdominal pain

Question 4

What is the relationship between brain tumours and children?

Answer 4

Brain tumours are the 2nd most common primary tumour in children

Question 5

Brain tumours are the commonest cause of cancer death in who?

Answer 5

Under 40s

Question 6

What are some environmental factors which may predispose to brain tumour development?

Answer 6

Immune suppression, whole brain irradiation (e.g. childhood leukaemia), smoking, oncogenic viruses

Question 7

Do primary brain tumours metastasise?

Answer 7

Very rarely outside of the CNS

Question 8

What are some general presentations of brain tumours?

Answer 8

Features of raised ICP, focal neurological deficit, headaches, seizures, change in mental status

Question 9

What is the most common focal neurological deficit to occur as a result of a brain tumour?

Answer 9

Motor weakness

Question 10

If the brain is so swollen as a result of a tumour, this can result in herniation of the brainstem. This can cause Cushing’s triad - what are the features of this?

Answer 10

Hypertension, bradycardia and abnormal respirations (irregular, decreased). There may also be a drop in GCS as well as a blown pupil.

Question 11

Tonsillar herniation is a pre-terminal event and must be immediately treated with what?

Answer 11

Mannitol

Question 12

Headaches caused by brain tumours usually occur as a result of what? What are some features of this?

Answer 12

Raised ICP - worse in the morning upon wakening, may actually wake the person up, worse on coughing/straining, may be associated nausea and vomiting

Question 13

How do clinical features of a brain tumour typically develop?

Answer 13

Usually chronic, developing over weeks-months or even years

Question 14

Why may a brain tumour cause an acute presentation?

Answer 14

Exponential increase in ICP due to herniation, haemorrhage or CSF obstruction

Question 15

Brain tumours may present later in who? Why?

Answer 15

The elderly, because they have more atrophy, giving a lesion more space to grow before it causes symptoms

Question 16

What are the major symptoms of a brain tumour affecting the frontal lobe?

Answer 16

Contralateral motor weakness, expressive dysphasia/aphasia, personality changes

Question 17

What are the major symptoms of a brain tumour affecting the parietal lobe?

Answer 17

Contralateral sensory loss, contralateral inferior quadrantinopia

Question 18

What are the major symptoms of a brain tumour affecting the temporal lobe?

Answer 18

Memory deficits, receptive dysphasia/aphasia, contralateral superior quadrantinopia

Question 19

What are the major symptoms of a brain tumour affecting the occipital lobe?

Answer 19

Macular sparing homonymous hemianopia, cortical blindness, visual hallucinations

Question 20

What are the major symptoms of a brain tumour affecting the sellar region?

Answer 20

Bitemporal hemianopia, endocrine dysfunction, cavernous sinus syndrome (CNIII-VI deficits)

Question 21

What are the major symptoms of a brain tumour affecting the brainstem?

Answer 21

Cranial nerve palsies (III-XII), decreased conscious level, abnormalities of the ascending and descending tracts

Question 22

What are the major symptoms of a brain tumour affecting the cerebellum?

Answer 22

Dysdiadochokinesia, ataxia, nystagmus, intention tremor, slurred speech, dizziness/vertigo, nausea/vomiting

Question 23

According to the SIGN guidelines, when should patients be referred for a new focal neurological deficit or change in behaviour?

Answer 23

If there is a progressive neurological deficit or progressive deterioration in cognition, behaviour or higher executive functions in the absence of previously diagnosed or suspected disorders such as MS

Question 24

What are the SIGN guidelines for referring a person with headache?

Answer 24

Headache and vomiting +/- papilloedema

Question 25

Which patients presenting with headache should you consider urgent referral for?

Answer 25

Patients with non-migrainous headache of recent onset, when accompanied by features of raised ICP, progressive neurological deficit or a new seizure disorder

Question 26

When a patient presents with signs of raised ICP, what is the most important thing to do?

Answer 26

Fundoscopy to assess if there is papilloedema

Question 27

What investigation is often used to confirm the presence of a space occupying lesion? It can then be followed up with what?

Answer 27

Plain CT / Contrast enhanced CT or MRI

Question 28

A contrast enhanced CT of a brain tumour often shows what?

Answer 28

A ring enhancing lesion

Question 29

If it seems that a brain tumour may be secondary, what are some important imaging tests to do?

Answer 29

CT chest, abdomen and pelvis

Question 30

What scans should be used when assessing brain tumours in children? Why?

Answer 30

MRI - CT scan increases the risk of thyroid cancers

Question 31

Describe a WHO grade 1 tumour?

Answer 31

Nil morphological features, well circumscribed, often curative with resection

Question 32

Describe a WHO grade 2 tumour?

Answer 32

Atypia alone, cannot always be completely excised

Question 33

Describe a WHO grade 3 tumour?

Answer 33

Atypia and mitosis, anaplasia

Question 34

Describe a WHO grade 4 tumour?

Answer 34

Atypia, mitosis and necrosis and vascular proliferation

Question 35

Describe which primaries are most likely to result in brain metastases?

Answer 35

Lung, breast, kidney, GI and melanoma

Question 36

On CT, brain metastases look very similar to what? How can you tell these apart?

Answer 36

Brain abscess / measure CRP or do an MRI

Question 37

What medication can be given to reduce cerebral oedema?

Answer 37

Steroids

Question 38

How do brain metastases get treated aside from treating the primary cancer?

Answer 38

Surgery ideally, or radiotherapy