CNS Neoplasms

Question 1

Primary Malignant Brain Tumors

Answer 1

Men > Women

More frequent in children

Question 2

Risk Factors for Brain Tumors

Answer 2

Genetic mutation
Neurofibromatosis
Exposure to high dose ionizing radiation

Question 3

High Dose Ionizing Radiation Possibilities

Answer 3

Radiation therapy
Atomic bomb survivors
CT scans
Dental xrays

Question 4

Classification of CNS Neoplasm

Answer 4

Grade 1: benign
Grade 2: malignant
Grade 3: malignant tissue that has cells that are actively growing
Grade 4: malignant tissue has cells that look most abnormal and tend to grow quickly

Question 5

Tumor Classifications

Answer 5

Neuroglial (Glioma)
Meningioma
Schwannoma

Question 6

Neuroglial (Glioma) Subtypes

Answer 6

Astrocytoma
Oligodendroglioma
Ependymoma

Question 7

Schwannoma Subtype

Answer 7

Acoustic neuroma

Question 8

Astrocytic Tumor Subtypes

Answer 8

Glioblastomas

Astrocytomas

Question 9

Astrocytic Tumor Grading

Answer 9

Grade 1: benign (almost always diagnosed in childhood)
Grade 2: slow growing and invade surrounding tissue
Grade 3: rare and require aggressive treatment due to tentacle like growth are hard to resect
Grade 4: aggressive fast growing cancer (Glioblastoma)

Question 10

Glioblastoma

Answer 10

Highly malignant
60-75% of all astrocytomas
Difficult to remove
Survival 2 years
Treatment: surgery, radiation, and chemotherapy

Question 11

Oligodendroglioma

Answer 11

Can be grade II-III
Frontal, temporal lobe
Slow growing

Question 12

Main Presenting Symptom of Oligodendroglioma

Answer 12

Seizure

Question 13

Frontal Lobe Oligodendroglioma

Answer 13

Weakness on one side of the body
Personality changes
Behavior changes
Difficulty with short term memory

Question 14

Treatment of Oligodendroglioma

Answer 14

Surgery
Radiation
Chemotherapy

Question 15

Prognosis of Oligodendroglioma

Answer 15

Survival 4-10 years

Question 16

Ependymal Cells

Answer 16

Cells line the ventricles of the brain and center of the spinal cord

Question 17

Ependymoma

Answer 17

More common in children

Peak at age 5-6 and 20-30

Question 18

Intracranial Ependymoma

Answer 18

Most common in kids
Poor prognosis
Symptoms of increased ICP: hydrocephalus, headache, N/V, ataxia, strabismus, irritability, altered mental status

Question 19

Spinal Cord Ependymoma

Answer 19

Most common in adults
Better prognosis
May cause cord compression symptoms
Most common spinal cord tumor

Question 20

Meningioma

Answer 20

20-30% of primary brain tumors

Most common primary brain tumor

Question 21

Meningioma Facts

Answer 21

More common in women
Benign
Usually grow inward putting pressure on brain and spinal cord
Can grow outward and cause thickening of the skull

Question 22

Treatment of Meningioma

Answer 22

Surgery

Radiation

Question 23

Meningioma Prognosis

Answer 23

5 year survival rate: 73-94%

Question 24

Meningioma Symptoms

Answer 24

Irritation: seizures
Compression: HA, focal weakness, dysphagia, apathy, somnolence
Stereotypic: CN deficits, change in mentation, visual changes, anosmia, exopthalmos, tongue atrophy
Vascular: compression of cerebral arteries
Misc: hydrocephalus, panhypopituitarism

Question 25

Tumors of the Cranial and Paraspinal Nerves

Answer 25

Schwannoma Neurofibroma Perineurioma Malignant Peripheral Nerve Sheath Tumor

Question 26

Schwannomas

Answer 26

Nerve sheath tumor Relatively slow growing Mostly benign Acoustic neuromas are the most common

Question 27

Acoustic Neuroma

Answer 27

Arises from 8th cranial nerve Benign Slow growing Can cause serious complications

Question 28

Acoustic Neuroma Symptoms

Answer 28

``` Unilateral hearing loss Tinnitus Occasional dizziness Difficulty swallowing Impaired eye movement Taste disturbance Unsteadiness ```

Question 29

Treatment of Acoustic Neuroma

Answer 29

Surgical excision Stereotactic radiation surgery Followed by observation fro growth

Question 30

Outcome and Prognosis Neuroma

Answer 30

Tinnitus- up to 60% relieved Recurrence- less that 5% (observe for 10 years) Hearing- preserved in 80% Facial Nerve Dysfunction: variable

Question 31

Primary CNS Lymphoma

Answer 31

Common in immunodeficiency syndromes Derived from B lymphocytes Occurs in the cerebral hemispheres

Question 32

Treatment of CNS Lymphoma

Answer 32

Steroids to decrease brain edema Chemotherapy Radiation

Question 33

Metastatic Tumors

Answer 33

Most common brain tumor

Question 34

Most Common Cancers to Metastasize to the Brain

Answer 34

``` Lung (16-20%) Renal Cell Cancer (7-10%) Malignant Melanoma (7%) Breast (5%) Colon (1-2%) ```

Question 35

Treatment of Metastatic Tumors

Answer 35

Radiation | Chemotherapy

Question 36

Neurologic Presentation of Generalized Tumors

Answer 36

``` Headaches Seizures N/V Depressed LOC Nerocognitive Dysfunction ```

Question 37

Neurologic Presentation of Focal Tumors

Answer 37

``` Seizures Weakness Sensory loss Aphasia Visual spatial dysfunction ```

Question 38

Symptoms of CNS Tumors

Answer 38

``` Headache Seizure Syncope N/V Numbness, tingling, weakness Balance issues Cognitive dysfunction ```

Question 39

Cognitive Dysfunction Symptoms

Answer 39

``` Personality changes Changes in memory, attention Altered language ability Problems with executive functioning Change in daily patterns of eating and sleeping ```

Question 40

Tumor Headaches in CNS Tumors

Answer 40

``` Dull, constant Bilateral, not throbbing Occipital/frontal lobes Increased coughing or straining Worse with change in body position Worse at night N/V Change in pattern from usual headache ```

Question 41

Most common symptoms of gliomas and cerebral metastases

Answer 41

Seizures

Question 42

Medical Management of Symptoms

Answer 42

Headache/brain edema- steroids | Seizures- anticonvulsants

Question 43

Imaging in Primary Care for CNS Tumors

Answer 43

MRI with gadolinium

Question 44

Neurosurgical Workup of CNS tumors

Answer 44

+/- lumbar puncture to examine cells +/- cerebral angiogram Biopsy

Question 45

Treatment of CNS Tumors

Answer 45

Surgical resection Chemotherapy Radiation