CNS

Question 1

– 55% of gliomas
– Peak incidence 6th decade
– Located in cerebral hemispheres
– Highly malignant, with evidence of necrosis and/or hemorrhage
– Usually present with sudden neurological deficit
– Median survival even with surgical resection and brain radiation is 18 months

Answer 1

Glioblastoma multiforme

Question 2

– 20-25% of gliomas
– Peaks in 6th decade
– Cerebral hemispheres
– Intermediate level of malignancy
– Presentation is with progressive neurologic deficit or seizures
– Survival is 18-20 months

Answer 2

Anaplastic astrocytoma

Question 3

– 20-25% of gliomas
– Peaks 1st and 4th decades
– Posterior fossa in children
– Cerebral hemispheres in adults

– Presentation:
Adults--seizures
Children--ataxia, seizures
– Survival:
Adults: 5-yr survival
Children: 90% for cerebellar, 50 % for brainstem

Answer 3

Low-grade astroglioma

Question 4

– 5% of gliomas
– 10% of brain tumors in kids
– Peaks 1st decade
– Location:
Kids--posterior fossa
Adults--supratentorial, spinal cord

– Symptoms:
Kids–nausea/emesis, ataxia
– 80% survival for supratentorial, 50% for posterior fossa

Answer 4

Ependymoma

Question 5

Most common pediatric brain tumor

Roof 4th ventricle

Presentation:
– Nausea, emesis, ataxia, lethargy

Answer 5

4% of intracranial tumors, Medulloblastoma

Question 6

– Prolactin (most common)
Presents with amenorrhea, galactorrhea, infertility, impotence
– Growth hormone
Acromegaly
– ACTH
Cushing’s disease

Answer 6

Secretory (endocrine) adenomas

Question 7

– Present with visual field defects

Answer 7

Non-secretory adenomas

Question 8

25% of all intracranial tumors

25-30% of cancer patients will develop intracranial mets

Spread is usally hematogenous

Most common primaries
– Lung, breast, melanoma, colon, kidney

Answer 8

Metastatic Tumors

Question 9

40% of ALL spinal tumors

Most are metastatic

Most common primary sites
– Lung
– Breast
– Lymphoma

Answer 9

Extradural tumors

Question 10

55% of PRIMARY spinal cord tumors

Usually benign tumors

Answer 10

Intradural/extramedullary

Question 11

15-30% of primary spinal cord tumors

Tumors:
– Ependymoma–from lining of central canal of spinal cord
– Astrocytoma

Answer 11

Intramedullary

Question 12

Clinical symptoms of Spinal Cord Tumors?

Answer 12

myelopathy

Question 13

work up?

Answer 13

– Plain films to rule out bony disease
– Magnetic resonance imaging of cervical or thoracic spine to visualize spinal cord
– Computed Tomography/Myelography (dye into spinal canal), in patients who
cannot have MRI