Brain Tumours (incl. Pit. Adenoma) - For Long case Flashcards
what is the most common brain tumour?
Cerebral Metastasis => secondary tumours
Primary brain tumours are more likely to be either supra or infratentorial based on the age of the patient presenting with it. What is meant by supra or infratentorial?
Which is more common for adults vs chidren
Without going into full detail, what clinical features (or groups of clinical features)would you be looking for in a patient presenting with a brain tumour
e.g sx of ICP rather than listing all of them
Where is the motor cortex?
Where is the sensory cortex?
Bonus points for including where specifically (i.e. which lobe)
Where is Broca’s and Wernicke’s areas specifically
Both typically located in the dominant hemisphere (left)
Broca = Inferior frontal gyrus of frontal lobe
Wernicke = Superior temporal gyrus extending into inferior parietal lobe
What are the features of a focal neurological deficit that you would like to elicit in a hx and/or exam
Whatre the main cerebellar signs?
Which tumours are most likely to metastasise to the brain?
Lung
Breast
GIT
RCC
Melanoma
What clinocal features of a brain tumour would you like to elicit in a case of suspected SOL (during hx and exam)
Very important to also ask questions about primary tumours
More complete list for raised ICP and Brainstem involvement:
For any SOL:
Sx of raised ICP:
1) Altered conciousness (GCS, confusion +/- Coma)
2) headache worse when lying flat/in morning),
3) N+V,
4) Blurred vision + Diplopia
5) Coma
6) Dizziness and light headedness (syncope but not syncope?)
Herniation/brainstem involvement =>
1) Cushing’s Triad: HTN, Bradycardia, Irregular resp (e.g. Cheyne Stokes breathing)
2) Cardio-resp compromise
3) CN palsies
4) Focal Neurological deficits
Go through the classification of primary brain tumours (no need for any of the details in the image, only list)
Astrocytomas are graded via which 2 systems. Go through them
Take note about the central necrosis in rapidly growing tumours => may lead to haemorrhage => Why we need T2 imaging specifically or alternatively repeat CT brain to monitor for this
Youve completed your history and exam for a suspected brain tumour. What investigations would you order (forget about the bloods)
What is the STOP protocol in the management of brain tumours
I would also include early referral to palliative care team once the decision is to treat and curative surgery is not longer reasonably attainable
The approach to surgical management of brain tumours involves Maximal tolerated surgical resection. What are some techniques employed to remove the tumour while causing minimal injury to healthy parenchyma? (3)
What if the above surgery cannot be performed or was inadequate (e.g. R1 margins), what else can be done?
If cannot undergo surgery, stereotactic radiosurgery could be used both to obtain a biopsy and eliminate malignant tissue
Chemoradiotherapy is used as an adjunct to surgery for brain tumours
What type of radiotherapy is employed?
What chemotherapy regimen is used?
External beam radiotherapy
Temozolomide (Alkylating agents that can cross the BBB easily)
What is the full management of Brain cancers?
Dont forget palliative care
What are the different presentations that a pituitary adenoma may present with?
The management of all the types of pituitary adenomas is typically surgical. What is this surgical procedure?
One type can actually be managed medically. Which one is it and how is it managed medically? Give one example of the medication class
Transsphenoidal resection (2nd line would be transcranial) +/- Stereotactic radiosurgery
Prolactinomas may be managed via Dopamine agonists e.g. bromocriptine
Octreotide for acromegaly as well Ty
What are the 2 major complications of pituitary adenomas (and not the tx only)
Pituitary apoplexy
Secondary Addisonian crisis
What is pituitary apoplexy and how is it managed?
Can it occur outside the setting of pituitary malignancies?
Emergency Question:
In the context of pituitary adenoma, why is an addisonian crisis relevant here?
what is the management of an addisonian crisis?
This is a secondary addisonian crisis rather than a primary as aldosterone and RAS are preserved
1) Non-functioning pituitary adenomas cause ACTH deficiency => cortisol deficiency
2) may also occur after pituitary tumour resection of functional tumours (most notably if Cushing’s disease present)
The only other setting is infection in Addison’s or abrupt withdrawal of steroids (not relevant here)
