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Neurology 2 > Clin Med - Intracranial neoplasm > Flashcards

Clin Med - Intracranial neoplasm Flashcards

1
Q

What are the three types of tumor?

A
  1. primary
  2. genetic/hereditary
  3. metastatic (MC)
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2
Q

Two types of primary tumors

A
  • Gliomas (MC)

- meningiomas

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3
Q

What type of cancers cause metastatic tumors in the brain

A

Lung > Breast > kidney > GI

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4
Q

Which type of primary tumor is more common in males? in females?

A

Males - gliomas

females - meningiomas

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5
Q

What type of tumors can be traced back to exposure to ionizing radiation (CT and X-rays)

A
  • meningiomas
  • gliomas
  • nerve sheath tumors
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6
Q

Primary CNS lymphoma is associated with waht

A
  • immunodeficiency

- “ghost tumors” bc very amenable to steroids

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7
Q

5 ways to classify tumors

A
  1. tissue of origin (glial cells, meningeal cells, metastasis)
  2. location
  3. primary vs. secondary (metastatic)
  4. grading
  5. staging (TMN)
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8
Q

Two ways to grade tumors

A
  1. microscopic appearance

2. growth rate

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9
Q

Classification of tumors based on location

A
  1. Intrinsic tumors (MC)
  2. Extrinsic tumors - arise from cranial and spinal nerves and dura
  3. tumors arising from adjacent structures: metastasis or pituitary gland
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10
Q

Two main location types of tumor

A
  • Supratentorium (in the cerebrum)

- Infratenotrium (in the cerebellum)

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11
Q

Incidence of supratentorial vs. infratentorial tumors in children vs. adults

A

Adults: supra (66%) > infra (33%)

Children: infra (66%) > supra (33%)

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12
Q

General presentation of supratentorial tumors

A
  • ICP
  • HA
  • focal deficits (weakness, dysphasia, seizure)
  • AMS
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13
Q

General presentation of infratentorial tumors

A
  • HA (ICP)
  • vertigo
  • n/v
  • brain stem = nystagmus
  • vermis = broad gait
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14
Q

Where are cerebral tumors in children most often (3)?

A
  • cerebellum
  • pons
  • optic nerve/chiasm

**supratentorial tumors are rare

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15
Q

Because supratentorial tumors are rare in children, what three sx are common and what one sx is unusual?

A
  • common: HA, vomiting, visual disturbance

- rare: epilepsy

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16
Q

General presentation of CNS tumors

A
  • neuro deficits (motor weakness and AMS)
  • HA
  • Seizure
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17
Q

General signs and symptoms of brain tumors (6)

A
  • cerebral edema
  • CSF obstruction (infratentorial/brain stem tumors)
  • ICP (dt CSF obstruction)
  • papilledema
  • focal neuro defects
  • pituitary dysfunction
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18
Q

Signs and symptoms of cerebral tumors

A
  • HA
  • vomiting
  • change in visual field/acuity
  • hemiparesis/hemiplegia (if near or on motor strip)
  • hypokinesia
  • decreased tactile discrimination
  • seizures
  • change in personality/behavior
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19
Q

Signs and symptoms of brain stem tumors

A
  • hearing loss (acoustic neuroma)
  • facial pain/weakness
  • dysphagia, decreased gag reflex
  • nystagmus
  • hoarseness
  • ataxia, dysarthria
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20
Q

what is the only type of brainstem tumor that can often be treated successfully?

A

acoustic neuroma

- the rest have a poor prognosis…

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21
Q

Signs and symptoms of cerebellar tumor

A

disturbances in coordination and equilibrium

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22
Q

Signs and symptoms of pituitary tumor

A
  • endocrine dysfunction
  • visual deficits (next to optic chiasm)
  • HA
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23
Q

Signs and symptoms of frontal lobe tumor

A
  • inappropriate behavior
  • personality changes
  • inability to concentrate
  • impaired judgement
  • memory loss
  • HA
  • expressive aphasia (Broca’s)
  • motor dysfunction
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24
Q

Signs and symptoms of parietal lobe tumor

A

Sensory deficits:

  • paresthesia
  • loss of two point discrimination
  • visual field deficits
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25
Q

Signs and symptoms of temporal lobe tumor

A
  • psychomotor seizures: no convulsions but loss of consciousness
  • hallucinations and visceral symptoms
  • Receptive aphasia (Wernicke’s)
26
Q

Signs and symptoms of occipital lobe tumor

A
  • visual disturbance
27
Q

Diagnostic procedures for CNS tumors

A
  • CT w and w/o
  • MRI w and w/o
  • plain film
  • myelography
  • PET scans
  • MRA to look at vascular supply of tumors
  • lumbar puncture/CSF analysis
  • pathology
28
Q

Why use contrast in MRI

A

tumors are very vascular, contrast enhances the vasculature

29
Q

What is CT best for? what can it miss

A

boney tumors

- can miss small lesions

30
Q

Surgical treatment of CNS tumors

A
  • resection of tumor
  • craniotomy
  • stereotaxis surgery
  • biopsy
  • transsphenoidal
31
Q

What is the goal of drug therapy related to CNS tumors

A
  • palliative care

- sx tx and to prevent complications

32
Q

Types of meds frequently used for CNS tumors

A
  • Analgesics
  • steroids (Decadron MC)
  • anti-seizure meds (Keppra MC)
  • histamine blockers
  • antiemetics
  • muscle relaxors
  • mannitol and hypertonic saline
  • NSAIDS - not used often dt bleed risk
33
Q

How to medically treat ICP?

A
  • mannitol

- 3% hypertonic saline (goal is Na+ 145-155, slightly high)

34
Q

List the 4 types of supratentorial tumor

A
  • meningiomas
  • gliomas
  • astrocytomas
  • glioblastoma multiform
  • oligodendroglioma
35
Q

What is the most common and most malignant of the gliomas

A

glioblastoma multiforme

36
Q

What are the two more benign forms of supratentorial tumor

A
  • meningiomas

- oligodendrogliomas (glioma)

37
Q

Meningioma

  • what cell type
  • how invasive?
A
  • arise from arachnoidal cap cells in the arachnoid membrane
  • usually non-invasive
38
Q

Meningioma

- three common locations

A
  • parasagittal region
  • sphenoid wing
  • parasellar region
39
Q

Meningioma

- presentation

A
  • asymptomatic

- if sx: focal/generalized seizures or gradually worsening neuro deficit

40
Q

Meningioma

- CT

A
  • isodense or hypodense
  • homogenous extra-axial mass with smooth or lobules
  • clear demarcated contours enhance homogeneously and densely with contrast
  • areas of calcification and produce hyperostosis of adjacent bone
41
Q

Meningioma

MRI

A
  • isodense with gray matter (T1)

- enhance with contrast, dural trail extending from tumor attachment

42
Q

Astrocytoma

- range

A

from benign to malignant

  • low grade pilocytic astrocytomas are benign
  • glioblastoma multiform are very malgnant
43
Q

Diffuse low grade astrocytoma

  • how infiltrative?
  • locations (2)
A
  • widely infiltrate surrounding tissue

- frontal region and subcortical white matter

44
Q

Diffuse low grade astrocytoma

- presentation

A
  • seizure
  • HA
  • slowly progressive neuro deficits
45
Q

Diffuse low grade astrocytoma

- CT

A
  • well circumscribed
  • non-enhancing (not much blood supply)
  • hypotenuse or isodense
  • more diffuse than meningioma
46
Q

Diffuse low grade astrocytoma

- MRI

A
  • more sensitive than CT, useful for ID and est. extent

- usually no enhancement

47
Q

Glioblastoma

  • how arise?
  • infiltration?
  • common appearance on imaging
  • prognosis
A
  • de novo or from low-grade glioma
  • infiltrates white matter tract, can cross corpus callosum
  • butterfly lesion
  • poor prognosis
48
Q

Glioblastoma

- locations (3)

A
  • frontal lobe
  • temoral lobe
  • basal ganglia
49
Q

Glioblastoma

- presentation

A
  • seizure
  • HA
  • slowly progressing neuro deficits
50
Q

Glioblastoma

- CT

A
  • hypodense or isodense
  • central hypodense area of necrosis surrounded by thick enhancing rim
  • surrounding edema
51
Q

Two types of infratentorial tumors

A
  • cerebellar astrocytomas

- medulloblastomas

52
Q

cerebellar astrocytomas

  • what age most common
  • prognosis
  • location
A
  • MC in childhood
  • most potentially curable of astrocytomas
  • posterior fossa
53
Q

cerebellar astrocytomas

- presentation

A
  • HA
  • n/v
  • gait unsteadiness
  • posterior head tilt with caudal tonsillar herniation
54
Q

cerebellar astrocytomas

- CT/MRI

A
  • tumor from vermis or cerebellar hemispheres

- large cyst with single enhancing mural nodule

55
Q

Medulloblastoma

  • what age most common
  • describe tumor
  • metastasis?
A
  • MC dx < 20 yo
  • soft, friable, often necrotic
  • can metastasize to CSF tracts
56
Q

Medulloblastoma

- location

A

75% in cerebellar vermis

57
Q

Medulloblastoma

- presentation

A
  • usually with signs of ICP

- CN deficits possible too

58
Q

Meduloblastomas

- MRI

A
  • contrast-enhancing midline or paramedic tumor
  • often compresses 4th ventricle
  • Gadolinium enhancement likely heterogenous
59
Q

What suspect if pt is neurologically intact and has unilateral dilated pupil?

A
  • posterior communicating artery aneurysm until proven otherwise
  • also possible they are herniating
  • CTA/MRI to prove
60
Q

Causes of altered consciousness

not just neoplasm related

A

q- ischemic stroke w/ edema

  • infarct with edema or hemorrhage
  • brain abscess
  • primary metastasis
  • post-traumatic edema
  • intracranial hematoma
61
Q

LOTS of pictures

A

to review in the slides

Neurology 2 (21 decks)

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