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Neurology- Clinical > Brain Tumours (Specific) > Flashcards

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?

A

Seizures

24
Q

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

A

‘Toothpaste appearance’

25
Q

Oligodendroglial tumours can be difficult to differentiate from which other tumour? Especially when?

A

Astrocytomas, especially when these co-exist and form collision tumours

26
Q

Oligodendroglial tumours are sensitive to what treatment? This can be used alongside what if required?

A

Chemotherapy e.g. procarbazine, vincristine / surgery

27
Q

What is the median survival of an oligodendroglial tumour?

A

10 years

28
Q

What are the most common extra-axial brain tumours?

A

Meningiomas

29
Q

Are meningiomas more commonly benign or malignant?

A

Benign (these are very rarely malignant or invade underlying brain tissue)

30
Q

Where do meningiomas arise from?

A

Arachnoid cap cells in the arachnoid membrane

31
Q

Surgical removal of meningiomas can be difficult due to them growing close to what other structures?

A

Dural venous sinuses

32
Q

How do meningiomas usually present?

A

Most often asymptomatic, but can present with headaches, focal neurological signs and cranial nerve palsies if affecting the skull base

33
Q

What are some risk factors for developing a meningioma?

A

Female, previous breast cancer, radiation in childhood

34
Q

What genetic condition is associated with meningiomas?

A

Neurofibromatosis type 2

35
Q

At what age is the peak incidence of meningiomas?

A

Mid-40s

36
Q

Aggressive types of meningiomas tend to occur following what and where?

A

After childhood leukaemia - in the midline

37
Q

Low-grade meningiomas can be treated with surgery. Higher grade tumours are also treated with surgery but should be followed up with what?

A

Radiotherapy

38
Q

What is the management of small meningiomas with no brain oedema that present only with seizures?

A

Monitoring, and an anti-epileptic drug

39
Q

What is the 5 year survival of a meningioma?

A

90%

40
Q

What are the two main types of nerve sheath tumours?

A

Neurofibromas and Schwannomas

41
Q

What is the most common nerve sheath tumour?

A

Vestibular schwannoma

42
Q

Vestibular Schwannomas most commonly arise where? What nerve do they affect?

A

The cerebellopontine angle - affecting the vestibular nerve

43
Q

The presence of bilateral vestibular Schwannomas is diagnostic of what?

A

Neurofibromatosis type 2

44
Q

How will a vestibular schwannoma present?

A

Hearing loss, tinnitus and vertigo

45
Q

Nerve sheath tumours present with symptoms/signs related to what?

A

Dysfunction in the specific affected nerve

46
Q

A vestibular schwannoma may compress what other nerve? What symptom can this cause?

A

CNVII - facial weakness

47
Q

What are some post-op complications of a vestibular Schwannoma?

A

Facial nerve palsy, loss of corneal reflex, nystagmus, abnormal eye movement

48
Q

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?

A

HCG, AFP and LDH / pineal tumour / chemotherapy

49
Q

If measurements of HCG, AFP and LDH are normal in a child with a midline tumour, what should be done next?

A

Biopsy and possible CSF sample

50
Q

What are some presenting complaints of a pituitary tumour?

A

Endocrine dysfunction, bitemporal hemianopia, headache

51
Q

A prolactinoma is treated how?

A

Cabergoline

52
Q

A growth hormone secreting pituitary adenoma is treated how?

A

Surgery and a somatostatin analogue

53
Q

What are some structures that might be infiltrated by a pituitary tumour?

A

CNIII, IV and VI, cavernous sinus and optic chiasm

54
Q

Infiltration of CNsIII, IV and VI by a pituitary tumour can cause what symptoms?

A

Diplopia and ophthalmoplegia

55
Q

What imaging investigation should be used for a suspected pituitary tumour? Which hormone level should be measured first and why?

A

MRI / prolactin - if it is a prolactinoma then it does not require surgery

56
Q

What are haemangioblastomas? Where do they usually arise?

A

Grade 1, benign, cystic, highly vascular tumours / posterior fossa-cerebellum

57
Q

Haemangioblastomas are most commonly associated with what condition?

A

Von-Hippel Lindau syndrome

Neurology- Clinical (31 decks)

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