Brain Tumours (General) Flashcards
Give an example of an a) intrinsic and b) extrinsic primary brain tumour?
a) Glioma b) Pituitary tumour, meningioma
Give examples of where a) supratentorial and b) infratentorial brain tumours would be found?
a) Cerebrum and sella turcica b) cerebellum and brainstem
Infratentorial brain tumours are seen most commonly in who? What do they present with?
Children - tiptoeing, ataxia, vomiting and abdominal pain
What is the relationship between brain tumours and children?
Brain tumours are the 2nd most common primary tumour in children
Brain tumours are the commonest cause of cancer death in who?
Under 40s
What are some environmental factors which may predispose to brain tumour development?
Immune suppression, whole brain irradiation (e.g. childhood leukaemia), smoking, oncogenic viruses
Do primary brain tumours metastasise?
Very rarely outside of the CNS
What are some general presentations of brain tumours?
Features of raised ICP, focal neurological deficit, headaches, seizures, change in mental status
What is the most common focal neurological deficit to occur as a result of a brain tumour?
Motor weakness
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?
Hypertension, bradycardia and abnormal respirations (irregular, decreased). There may also be a drop in GCS as well as a blown pupil.
Tonsillar herniation is a pre-terminal event and must be immediately treated with what?
Mannitol
Headaches caused by brain tumours usually occur as a result of what? What are some features of this?
Raised ICP - worse in the morning upon wakening, may actually wake the person up, worse on coughing/straining, may be associated nausea and vomiting
How do clinical features of a brain tumour typically develop?
Usually chronic, developing over weeks-months or even years
Why may a brain tumour cause an acute presentation?
Exponential increase in ICP due to herniation, haemorrhage or CSF obstruction
Brain tumours may present later in who? Why?
The elderly, because they have more atrophy, giving a lesion more space to grow before it causes symptoms
What are the major symptoms of a brain tumour affecting the frontal lobe?
Contralateral motor weakness, expressive dysphasia/aphasia, personality changes
What are the major symptoms of a brain tumour affecting the parietal lobe?
Contralateral sensory loss, contralateral inferior quadrantinopia
What are the major symptoms of a brain tumour affecting the temporal lobe?
Memory deficits, receptive dysphasia/aphasia, contralateral superior quadrantinopia
What are the major symptoms of a brain tumour affecting the occipital lobe?
Macular sparing homonymous hemianopia, cortical blindness, visual hallucinations
What are the major symptoms of a brain tumour affecting the sellar region?
Bitemporal hemianopia, endocrine dysfunction, cavernous sinus syndrome (CNIII-VI deficits)
What are the major symptoms of a brain tumour affecting the brainstem?
Cranial nerve palsies (III-XII), decreased conscious level, abnormalities of the ascending and descending tracts
What are the major symptoms of a brain tumour affecting the cerebellum?
Dysdiadochokinesia, ataxia, nystagmus, intention tremor, slurred speech, dizziness/vertigo, nausea/vomiting
According to the SIGN guidelines, when should patients be referred for a new focal neurological deficit or change in behaviour?
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
What are the SIGN guidelines for referring a person with headache?
Headache and vomiting +/- papilloedema
Which patients presenting with headache should you consider urgent referral for?
Patients with non-migrainous headache of recent onset, when accompanied by features of raised ICP, progressive neurological deficit or a new seizure disorder
When a patient presents with signs of raised ICP, what is the most important thing to do?
Fundoscopy to assess if there is papilloedema
What investigation is often used to confirm the presence of a space occupying lesion? It can then be followed up with what?
Plain CT / Contrast enhanced CT or MRI
A contrast enhanced CT of a brain tumour often shows what?
A ring enhancing lesion
If it seems that a brain tumour may be secondary, what are some important imaging tests to do?
CT chest, abdomen and pelvis
What scans should be used when assessing brain tumours in children? Why?
MRI - CT scan increases the risk of thyroid cancers
Describe a WHO grade 1 tumour?
Nil morphological features, well circumscribed, often curative with resection
Describe a WHO grade 2 tumour?
Atypia alone, cannot always be completely excised
Describe a WHO grade 3 tumour?
Atypia and mitosis, anaplasia
Describe a WHO grade 4 tumour?
Atypia, mitosis and necrosis and vascular proliferation
Describe which primaries are most likely to result in brain metastases?
Lung, breast, kidney, GI and melanoma
On CT, brain metastases look very similar to what? How can you tell these apart?
Brain abscess / measure CRP or do an MRI
What medication can be given to reduce cerebral oedema?
Steroids
How do brain metastases get treated aside from treating the primary cancer?
Surgery ideally, or radiotherapy
