Brain tumours (Primary)

Question 1

Where may the tumour affect?

Answer 1

Brain
Meninges
Pituitary gland 
Pineal gland 
Cranial nerves

Question 2

What does:

• Grade 1
• Grade 2
• Grade 3 and 4

mean?

Answer 2

Doesn’t spread - benign

May spread slowly and may recur if removed - benign

Malignant tumours which spreads
Recurs if removed

Question 3

Why might a benign brain tumour still be harmful?

Answer 3

Mass effect - https://radiopaedia.org/articles/intracranial-mass-effect-summary?lang=gb

Question 4

What sex are they commoner in?

Answer 4

Men

Question 5

Presentation:

Raised ICP - how will this present? DON’T FORGET FUNDOSCOPY - 3

Focal signs? - 4

What is the onset like?

Answer 5

Raised ICP - headache, N&V, papilloedema

Focal signs - seizures, visual symptoms, cerebellar signs, personality changes

Progressive and subacute onset

Question 6

Low-grade brain tumours:

Meningioma:

• What percentage of all primary brain tumours does this make up?
• What sex is it commoner in?

Pituitary adenoma:

• What percentage of all primary brain tumours does this make up?
• It may cause endocrine symptoms:
  - What hormone could be increased?
  - What syndrome may it cause?
  - You can get too much growth hormone. What is this called?

Answer 6

25% of primary brain tumours
Women

15% of primary brain tumours

Prolactin
Cushing’s disease - too much cortisol
Acromegaly

Question 7

Low-grade brain tumours - Acoustic neuroma:

• What is it?
• What is another name for it?
• What is it associated with?
• How does it present first? - 2
• What presents after this? - 4
• Management - 2

Answer 7

Benign tumour of CN 8 Schwann cells 
Vestibular schwannoma 
Neurofibromatosis type 2 - NF 2
--------
Unilateral sensorineural deafness and pressure in one ear 

Unilateral face numbness
Absent corneal reflex (due to CN5 compression)
Vertigo
N&V
————
Slow growing, so small tumours can be monitored with annual MRI
Surgery

Question 8

High-grade brain tumours:

Gliomas:

• What percentage of all primary brain tumours does this make up?
• What sex is it commoner in?

Astrocytoma is the commonest type of glioma.

• What type is the commonest MALIGNANT tumour in adults?
• What type is the commonest BENIGN tumour in kids?

Answer 8

Glioblastoma - mean onset 55 yrs

Pilocytic astrocytoma (PCA)

Question 9

High-grade brain tumours:

Medulloblastoma:

• Why is this important in kids?
• How do these present?

Primary CNS lymphoma - what chronic infection is linked to this?

Answer 9

Most common MALIGNANT tumour in kids

Hydrocephalus
Cerebellar signs - abnormal gait and coordination

Question 10

Investigations

Answer 10

MRI/CT with contrast

Histology from biopsy or resection

Question 11

Management

Answer 11

Surgical resection

Radiotherapy (external beam or stereotactic) - low grade

Adjunct (high grade) to surgery

Question 12

Brain metastases:

Where do they mostly come from? - 3

Presentation?

Diagnosis?

Answer 12

Breast
Lung
Melanoma
Kidneys

Same as primary - raised ICP and/or focal neurology

CT/MRI + contrast

Question 13

Brain metastases:

Management:

• Why do you give dexamethasone?
• What can be done for a single brain mets?
• What can be done for multiple brain mets?

Answer 13

REDUCES OEDEMA from tumour - vasogenic oedema - Vasogenic edema is defined as extracellular accumulation of fluid resulting from disruption of the blood-brain barrier (BBB) and extravasations of serum proteins, while cytotoxic edema is characterized by cell swelling caused by intracellular accumulation of fluid.

Surgery and/or radiotherapy

Chemo or whole brain radiotherapy

Question 14

Brain metastases:

What is the prognosis?

Answer 14

1 month