Brain tumours/metastasis

Question 1

A headache alongside which features may indiciate intracranial hypertension?

Answer 1

• Constant headache
• Nocturnal
• Worse on waking
• Worse on coughing, straining or bending forward
• Vomiting
• Papilloedema on fundoscopy

Question 2

What is papilloedema?

Answer 2

Swelling of the optic disc seen on fundoscopy secondary to raised intracranial pressure

Question 3

What are gliomas and the 3 main types?

Answer 3

Tumours of the glial cells in the brain or spinal cord

Glial cells- Astrocytes, oligodendrocytes and ependymal cells

Graded from 1-4
* 1- most benign (most curable with surgery)
* 4- most malignant

Types:
* Astrocytoma (most common and agressive form of glioblastoma )
* Oligodendroglioma
* Ependymoma

Question 4

What are meningiomas?

Answer 4

Tumours growing from the cells of the meninges- usually benign

They take up space= raised intracranial pressure and neuological symptoms

Question 5

Cancers that most often spread to the brain?

Answer 5

• Lung
• Breast
• Renal cell carcinoma
• Melanoma

Question 6

Pituitary tumours- what they cause and management?

Answer 6

Tend to benign

Can press on optic chiasm causing visual field defect- bitemporal hemianopia- loss of the outer half of the visual fields in both eyes

Can cause:
* Acromegaly (excessive growth hormone)
* Hyperprolactinaemia (excessive prolactin)
* Cushing’s disease (excessive cortisol and ACTH)
* Thyrotoxicosis (excessive TSH and thyroid hormone)

Management:
* Trans-sphenoidal surgery (through the nose and sphenoid bone)
* Radiotherapy
* Bromocriptine to block excess prolactin
* Somatostatin analogues (e.g. octreotide) to block excess growth hormone

Question 7

What are acoustic neuromas? Presentation and management?

Answer 7

Benign tumours of the schwann cells that surround the auditory nerve that innervates the inner ear= vestibular schwannomas

Occur at the cerebellopontine angle and are sometimes called cerebellopontine angle tumours

Unilateral

Typical presentation- 40-60 year old with gradual onset of:
* Unilateral sensorineural hearing loss
* Unilateral tinnitus
* Dizziness or imbalance
* Sensation of fullness in the ear
* Facial nerve palsy- if tumour grows large enough to compress the facial nerve

Management:
* Conservative managment with monitoring
* Surgery
* Radiotherapy

Question 8

Primary vs secondary brain tumours?

Answer 8

Primary- arise from the meninges (meningioma) or glial cells (gliomas or astrocytomas)

Secondary- arise from bronchus, breast, stomach, prostate, thyriod or kidneys

Question 9

What medication is given to reduce oedema surrounding a space occupying lesion for symptomatic relief?

Answer 9

Dexamethasone