CNS Flashcards by Julia Mulder

MOST COMMON Brain cancer type

glioma

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where are most primary brain cancers located

cerebrum

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most common area for palliative brain cancer

cerebral hemisphere

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cerebrum functions

memory, reasoning, judgement, intelligence, emotions and voluntary muscle mvmnt

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cerebellum functions

plays role in coordination and voluntary muscle mvmnt

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3 most important prognostic factors

age, tumour type and performance status

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HOW much CSF IS EXCREETED / DAY

.5L

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where is CSF excreteed from

the ependymal cells in the choroid plexus

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what seperates the the supratentorium from the infraentorium

tentorium

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what portion of CNS is white matter? grey matter?

white is 60%

grey is 40%

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what is the blood supply of the brain? spinal cord?

brain- circle of willis

SC- vertebral arteries

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where is thed end of the spinal cord? T level?

L1-2`

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WHAT type of substances are allowed past the BBB? which are not?`

lipid soluble substances are allowed past

water soluble substances are NOT allowed past unless accompanied by a transporter protein

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ex of lipid soluble substances

alcohol, nicotine and heroin

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ex of water soluble substances

glucose, amino acids and sodium

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how much CSF is circulating through the CNS

3-5oz

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cervical spine involvement S&S

arm weakness, - pain and temperature sensation in cervical region

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thoracic spine involvement s &s

abdo muscle weakness, unilateral root pains, sensory changes

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lumbarsacral spine involvement s&s

root pain in groin, impotence, bladder paralysis, - knee jerk

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cauda equina involvement s&s

unilateral pain in back and leg, bladder and bowel paralysis

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most common area of drop mets

the LS spine

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initial symptom in Brain cancer

headache which is worse in the morning due to ambulation

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brain cancer symptoms are usually ______

unilateral

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spinal cord cancers are usually ______

bilateral

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pattern of weakness in spinal cord cancer

starts distally and moves proximlly

outr most layer of brain meninges

dura mater

mid layer of brain meninges

arachnoid mater

innermost layer of brain mninges

pia mater

what area is responsible for speech

brocas area- in the frontal lobe

functions of frontal lobe

Voluntary movements, speech Behavioural and cognitive decline Reasoning, judgement emotional response and completion of complex actions and control of voluntary muscle movement Frontal lobe holds Broca’s area- the area of the brain responsible for speech and movement

functions parietal lobe

Sensory input, body orientation, somatic centre Sensory/motor disturbances Temperature, touch pressure, vibration, pain and taste Writing and some aspects of reading

Functions tempral lobe

Memory and auditory and smell Memory and hearing deficits Language functions

where is memory formed

amygdala and hippocampus located at the parahippocampal gyrus which is in the temporal lobe

functions of occipital lobe

Perception of visual stimuli | Visual problems

what part of the brain is responsible for vision

occipital lobe

what part is responsible for hearig

temporal lobe

what part of the brain is responsible for touch and sensatiob

parietal lobe

what part of the brain is responsible for reasoning and behaviour

frontal lobe

specific s&s for malignant astrocytoma

hadache seizure weakness and mental changes

specific s&s of brainstem

n&v and ataxia

meningioma s&s

headache and seizure

medulloblastoma s&s

morning headache and n&v

ependymoma s&s

morning headache and n&v

chraniopharyngioma s&s

headache mental changes hemaplageia, seizure and vomiting

olgiodendroglioma s&s

headache and mental changes

pinealoma s&s

ocula, vertibular and endocrine

hemangioma s&s

migrane

if a 90atient has reading and writing comprehension difficulties where is their promary

parietal lobe

pt has personalit changes, memory defects, gait and speech problems, where is the primary tumour

frontal lobe8u9

what part of the brIain controls Controls BP, HR and breathing rate

the medulla oblongata

i am part of the brain that Coordination center for motor functions maintains muscle tone, posture and balance

cerebellum

what are the parts of the circle of willis

ant communicating artery, mid cerebral artery, post communicating artery, int carotid artery and post cerbral artery

which lobe presents earliest

parietal lobe

what lobes have vision changes

parietal and occipital lobe

what lobe presents later than other lobes

frontal lobe

speech disorders in the temporal lobe occur most commonly in what hemisphere

more commonly in left hemisphere

temporary alopecia dose

20-40Gy

what dose can cause perm alopecia

>40Gy

what cancers get CSI

meduloblastoma, germ cell tumours and ependymoma

CSI procedure

pt is treated prone and has 2 lats for whole brain and 1 + spine fields

beam divergence in CSI

"Feathering th gap" -SHIFTS TH GAP between the brain and spine fields by 1cm every 1000 cgy spine field is shifted superiorly to accomodate the gap and fs is expanded sup and inf can also be changed by a couch kick to form a straight edge

most common bening brain tumour

acoustic nueuroma

how long does it take for dexamehasone to work

12-18hours

do all patients get dexamethasone

no patients should not get dex until they have symptoms

when is mannitol used for CNS patients

its done with dexamethasone to - peritumoral edema in steroid refactory pts (recurrence after initial response to dex)

what medications can be used for seizures

benzodiazapenes and phenyotin

when are stents placed

life threatening hydrcephalus, mass effect and neurologic impairement

what is th treatment for boh hemispheres (XRT)

6 NONCOPLANAR BEAMS 2beams on the right 2 beams on the left 2 sup obliques

for CSI XRT what is the inf portion of the spinr field (Tlvel)

CSI feathering the gap couch rotation typical angles

9-11

drawbacks of couch rotation for junctioning field

the contralatral eye can not be blocked without blocking the frontal lobe this can also underdose the temporal lobe and cribiform plate

what is CCNU chemotherapy

lomustine

treatment of low grade glioma

surgery- maximal resection possible adjuvant XRT 45-54Gy stage 2 nonpilocytic cancer can get chemo (PCV or lomustine or TMZ)

what is PCV chemotherapy

procarzabine, lomostine and vincristine

treatment for high grade glioma

MSR -> chemorads (60Gy +TMZ) -> ADJUVANT XRT TMZ

Dose for high grade glioma

tumour +edema to 46gy + 14Gy boost | 40/15 for elderly pts

margins high grade glioma

2-3cm

most common location ependymoma

post fossa and cauda equina

tumours of cauda equina ependymoma are what subtype

myxopapillary type (WHO GRADE1)

Tumours of C/T spine ependymoma are wha subtype

cellulaR SUBTPE (Grade2-3)

treatment ependymoma

MSR-XRT (CSI) 36-40gy with boost to 50-54Gy

treatment brainstm glioma

not typically treated with surgery except for shunt placement for hydrocephalus therefore chemo rads is tx of choice, TMZ + 54-60Gy

mawrgins brainstem glioma

``` CTV= GTV +1-1.5CM PTV= CTV +3-5MM ```

treatment meduloblastoma / pnt

``` maximal surgical resection in all patients followed by chemorads CSI (30-40gY + boost to post fossa 10-25gy with total dose of 50-55 + vincristine adjuvant chemotherapy (lomusine + cisplatinum) ```