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Brain Tumours (Specific) Flashcards

1
Q

Gliomas are tumours which originate from where? Give specific examples.

A

Neuroepithelial cells e.g. astrocytes, oligodendrocytes or ependymal cells

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2
Q

What is the main name for each of the following grades of astrocytoma: a) grade 1? b) grade 2? c) grade 3? d) grade 4?

A

a) pilocytic astrocytoma b) diffuse astrocytoma c) anaplastic astrocytoma d) glioblastoma multiforme

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3
Q

What is the most common primary paediatric tumour in the brain?

A

Pilocytic astrocytoma

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4
Q

Who do grade 1 astrocytomas usually occur in?

A

Mostly in children and young adults

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5
Q

Where are grade 1 astrocytomas most likely to arise in a) children? b) adults?

A

a) cerebellum or brainstem b) optic nerve or hypothalamus

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6
Q

In adults, grade 1 astrocytomas are often associated with which condition?

A

Neurofibromatosis type 1

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7
Q

How are grade 1 astrocytomas usually treated? Which ones should you leave alone?

A

Usually curative with surgical resection, avoid surgical management of those in the optic nerve due to risk of blindness

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8
Q

Why are grade 2 astrocytomas difficult to surgically excise?

A

Because they lack a definitive margin between tumour an non-tumour tissue

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9
Q

Are grade 2 astrocytomas likely to progress?

A

These are pre-malignant and are likely to evolve into a higher grade tumour

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10
Q

Grade 2 astrocytomas have a predilection for which areas of the brain?

A

Temporal lobe, posterior frontal lobe and anterior parietal lobe

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11
Q

How will grade 2 astrocytomas most likely present?

A

Seizures

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12
Q

What are some poor prognostic factors of grade 2 astrocytomas?

A

Aged > 50, focal deficit, short duration of symptoms, raised ICP, altered consciousness

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13
Q

How are grade 2 astrocytomas treated?

A

Surgery to remove as much of the tumour as possible and then radio/chemotherapy depending on the molecular profile of the tumour

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14
Q

How may grade 3 astrocytomas arise? What is their median survival?

A

Can arise de novo or can be progression from a grade 2 tumour / 2 years

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15
Q

What is the most common malignant primary brain tumour in adults? What is its median survival?

A

Glioblastoma multiforme / < 1 year

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16
Q

Glioblastoma multiforme is most likely to present in who?

A

Adults in their 50s/60s

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17
Q

Where in the brain does glioblastoma multiforme most commonly arise?

A

In the cerebral hemispheres

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18
Q

Describe the onset of clinical features of glioblastoma multiforme?

A

Usually rapid onset, most commonly raised ICP and focal neurological deficit

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19
Q

What is the treatment of gliobastoma multiforme? What is the purpose of this treatment?

A

Remove as much of the tumour surgically as possible and give radiotherapy +/- chemotherapy / non-curative treatment, for survival quality only

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20
Q

Following brain surgery, it is not safe for patients to drive if they have what? What should you do about this?

A

Seizure risk or a significant homonymous visual field defect - advise patient to inform DVLA

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21
Q

Oligodendroglial tumours are most likely to occur where?

A

In the frontal lobes

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22
Q

Who do oligodendroglial tumours most commonly occur in?

A

Usually adults aged 25-45, with a small peak in children aged 6-12

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23
Q

How do oligodendroglial tumours usually present?

24
Q

Subarachnoid accumulations of oligodendroglial tumours are characterised as having what appearance?

A

‘Toothpaste appearance’

25
Oligodendroglial tumours can be difficult to differentiate from which other tumour? Especially when?
Astrocytomas, especially when these co-exist and form collision tumours
26
Oligodendroglial tumours are sensitive to what treatment? This can be used alongside what if required?
Chemotherapy e.g. procarbazine, vincristine / surgery
27
What is the median survival of an oligodendroglial tumour?
10 years
28
What are the most common extra-axial brain tumours?
Meningiomas
29
Are meningiomas more commonly benign or malignant?
Benign (these are very rarely malignant or invade underlying brain tissue)
30
Where do meningiomas arise from?
Arachnoid cap cells in the arachnoid membrane
31
Surgical removal of meningiomas can be difficult due to them growing close to what other structures?
Dural venous sinuses
32
How do meningiomas usually present?
Most often asymptomatic, but can present with headaches, focal neurological signs and cranial nerve palsies if affecting the skull base
33
What are some risk factors for developing a meningioma?
Female, previous breast cancer, radiation in childhood
34
What genetic condition is associated with meningiomas?
Neurofibromatosis type 2
35
At what age is the peak incidence of meningiomas?
Mid-40s
36
Aggressive types of meningiomas tend to occur following what and where?
After childhood leukaemia - in the midline
37
Low-grade meningiomas can be treated with surgery. Higher grade tumours are also treated with surgery but should be followed up with what?
Radiotherapy
38
What is the management of small meningiomas with no brain oedema that present only with seizures?
Monitoring, and an anti-epileptic drug
39
What is the 5 year survival of a meningioma?
90%
40
What are the two main types of nerve sheath tumours?
Neurofibromas and Schwannomas
41
What is the most common nerve sheath tumour?
Vestibular schwannoma
42
Vestibular Schwannomas most commonly arise where? What nerve do they affect?
The cerebellopontine angle - affecting the vestibular nerve
43
The presence of bilateral vestibular Schwannomas is diagnostic of what?
Neurofibromatosis type 2
44
How will a vestibular schwannoma present?
Hearing loss, tinnitus and vertigo
45
Nerve sheath tumours present with symptoms/signs related to what?
Dysfunction in the specific affected nerve
46
A vestibular schwannoma may compress what other nerve? What symptom can this cause?
CNVII - facial weakness
47
What are some post-op complications of a vestibular Schwannoma?
Facial nerve palsy, loss of corneal reflex, nystagmus, abnormal eye movement
48
Any child with a midline tumour should have what things measured? This is because there is a suspicion of what? If the tumour is positive for those things, it will be sensitive to what treatment?
HCG, AFP and LDH / pineal tumour / chemotherapy
49
If measurements of HCG, AFP and LDH are normal in a child with a midline tumour, what should be done next?
Biopsy and possible CSF sample
50
What are some presenting complaints of a pituitary tumour?
Endocrine dysfunction, bitemporal hemianopia, headache
51
A prolactinoma is treated how?
Cabergoline
52
A growth hormone secreting pituitary adenoma is treated how?
Surgery and a somatostatin analogue
53
What are some structures that might be infiltrated by a pituitary tumour?
CNIII, IV and VI, cavernous sinus and optic chiasm
54
Infiltration of CNsIII, IV and VI by a pituitary tumour can cause what symptoms?
Diplopia and ophthalmoplegia
55
What imaging investigation should be used for a suspected pituitary tumour? Which hormone level should be measured first and why?
MRI / prolactin - if it is a prolactinoma then it does not require surgery
56
What are haemangioblastomas? Where do they usually arise?
Grade 1, benign, cystic, highly vascular tumours / posterior fossa-cerebellum
57
Haemangioblastomas are most commonly associated with what condition?
Von-Hippel Lindau syndrome

Neurology- Clinical (31 decks)

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