Clin Med - Intracranial neoplasm Flashcards
What are the three types of tumor?
- primary
- genetic/hereditary
- metastatic (MC)
Two types of primary tumors
- Gliomas (MC)
- meningiomas
What type of cancers cause metastatic tumors in the brain
Lung > Breast > kidney > GI
Which type of primary tumor is more common in males? in females?
Males - gliomas
females - meningiomas
What type of tumors can be traced back to exposure to ionizing radiation (CT and X-rays)
- meningiomas
- gliomas
- nerve sheath tumors
Primary CNS lymphoma is associated with waht
- immunodeficiency
- “ghost tumors” bc very amenable to steroids
5 ways to classify tumors
- tissue of origin (glial cells, meningeal cells, metastasis)
- location
- primary vs. secondary (metastatic)
- grading
- staging (TMN)
Two ways to grade tumors
- microscopic appearance
2. growth rate
Classification of tumors based on location
- Intrinsic tumors (MC)
- Extrinsic tumors - arise from cranial and spinal nerves and dura
- tumors arising from adjacent structures: metastasis or pituitary gland
Two main location types of tumor
- Supratentorium (in the cerebrum)
- Infratenotrium (in the cerebellum)
Incidence of supratentorial vs. infratentorial tumors in children vs. adults
Adults: supra (66%) > infra (33%)
Children: infra (66%) > supra (33%)
General presentation of supratentorial tumors
- ICP
- HA
- focal deficits (weakness, dysphasia, seizure)
- AMS
General presentation of infratentorial tumors
- HA (ICP)
- vertigo
- n/v
- brain stem = nystagmus
- vermis = broad gait
Where are cerebral tumors in children most often (3)?
- cerebellum
- pons
- optic nerve/chiasm
**supratentorial tumors are rare
Because supratentorial tumors are rare in children, what three sx are common and what one sx is unusual?
- common: HA, vomiting, visual disturbance
- rare: epilepsy
General presentation of CNS tumors
- neuro deficits (motor weakness and AMS)
- HA
- Seizure
General signs and symptoms of brain tumors (6)
- cerebral edema
- CSF obstruction (infratentorial/brain stem tumors)
- ICP (dt CSF obstruction)
- papilledema
- focal neuro defects
- pituitary dysfunction
Signs and symptoms of cerebral tumors
- HA
- vomiting
- change in visual field/acuity
- hemiparesis/hemiplegia (if near or on motor strip)
- hypokinesia
- decreased tactile discrimination
- seizures
- change in personality/behavior
Signs and symptoms of brain stem tumors
- hearing loss (acoustic neuroma)
- facial pain/weakness
- dysphagia, decreased gag reflex
- nystagmus
- hoarseness
- ataxia, dysarthria
what is the only type of brainstem tumor that can often be treated successfully?
acoustic neuroma
- the rest have a poor prognosis…
Signs and symptoms of cerebellar tumor
disturbances in coordination and equilibrium
Signs and symptoms of pituitary tumor
- endocrine dysfunction
- visual deficits (next to optic chiasm)
- HA
Signs and symptoms of frontal lobe tumor
- inappropriate behavior
- personality changes
- inability to concentrate
- impaired judgement
- memory loss
- HA
- expressive aphasia (Broca’s)
- motor dysfunction
Signs and symptoms of parietal lobe tumor
Sensory deficits:
- paresthesia
- loss of two point discrimination
- visual field deficits
Signs and symptoms of temporal lobe tumor
- psychomotor seizures: no convulsions but loss of consciousness
- hallucinations and visceral symptoms
- Receptive aphasia (Wernicke’s)
Signs and symptoms of occipital lobe tumor
- visual disturbance
Diagnostic procedures for CNS tumors
- 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
Why use contrast in MRI
tumors are very vascular, contrast enhances the vasculature
What is CT best for? what can it miss
boney tumors
- can miss small lesions
Surgical treatment of CNS tumors
- resection of tumor
- craniotomy
- stereotaxis surgery
- biopsy
- transsphenoidal
What is the goal of drug therapy related to CNS tumors
- palliative care
- sx tx and to prevent complications
Types of meds frequently used for CNS tumors
- 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
How to medically treat ICP?
- mannitol
- 3% hypertonic saline (goal is Na+ 145-155, slightly high)
List the 4 types of supratentorial tumor
- meningiomas
- gliomas
- astrocytomas
- glioblastoma multiform
- oligodendroglioma
What is the most common and most malignant of the gliomas
glioblastoma multiforme
What are the two more benign forms of supratentorial tumor
- meningiomas
- oligodendrogliomas (glioma)
Meningioma
- what cell type
- how invasive?
- arise from arachnoidal cap cells in the arachnoid membrane
- usually non-invasive
Meningioma
- three common locations
- parasagittal region
- sphenoid wing
- parasellar region
Meningioma
- presentation
- asymptomatic
- if sx: focal/generalized seizures or gradually worsening neuro deficit
Meningioma
- CT
- 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
Meningioma
MRI
- isodense with gray matter (T1)
- enhance with contrast, dural trail extending from tumor attachment
Astrocytoma
- range
from benign to malignant
- low grade pilocytic astrocytomas are benign
- glioblastoma multiform are very malgnant
Diffuse low grade astrocytoma
- how infiltrative?
- locations (2)
- widely infiltrate surrounding tissue
- frontal region and subcortical white matter
Diffuse low grade astrocytoma
- presentation
- seizure
- HA
- slowly progressive neuro deficits
Diffuse low grade astrocytoma
- CT
- well circumscribed
- non-enhancing (not much blood supply)
- hypotenuse or isodense
- more diffuse than meningioma
Diffuse low grade astrocytoma
- MRI
- more sensitive than CT, useful for ID and est. extent
- usually no enhancement
Glioblastoma
- how arise?
- infiltration?
- common appearance on imaging
- prognosis
- de novo or from low-grade glioma
- infiltrates white matter tract, can cross corpus callosum
- butterfly lesion
- poor prognosis
Glioblastoma
- locations (3)
- frontal lobe
- temoral lobe
- basal ganglia
Glioblastoma
- presentation
- seizure
- HA
- slowly progressing neuro deficits
Glioblastoma
- CT
- hypodense or isodense
- central hypodense area of necrosis surrounded by thick enhancing rim
- surrounding edema
Two types of infratentorial tumors
- cerebellar astrocytomas
- medulloblastomas
cerebellar astrocytomas
- what age most common
- prognosis
- location
- MC in childhood
- most potentially curable of astrocytomas
- posterior fossa
cerebellar astrocytomas
- presentation
- HA
- n/v
- gait unsteadiness
- posterior head tilt with caudal tonsillar herniation
cerebellar astrocytomas
- CT/MRI
- tumor from vermis or cerebellar hemispheres
- large cyst with single enhancing mural nodule
Medulloblastoma
- what age most common
- describe tumor
- metastasis?
- MC dx < 20 yo
- soft, friable, often necrotic
- can metastasize to CSF tracts
Medulloblastoma
- location
75% in cerebellar vermis
Medulloblastoma
- presentation
- usually with signs of ICP
- CN deficits possible too
Meduloblastomas
- MRI
- contrast-enhancing midline or paramedic tumor
- often compresses 4th ventricle
- Gadolinium enhancement likely heterogenous
What suspect if pt is neurologically intact and has unilateral dilated pupil?
- posterior communicating artery aneurysm until proven otherwise
- also possible they are herniating
- CTA/MRI to prove
Causes of altered consciousness
not just neoplasm related
q- ischemic stroke w/ edema
- infarct with edema or hemorrhage
- brain abscess
- primary metastasis
- post-traumatic edema
- intracranial hematoma
LOTS of pictures
to review in the slides
