CNS Tumors Flashcards
What is the primary imaging study for the neurological system?
What are the pros to this imaging study ?
1.
2.
3.
You use contrast for ___________ or ___________
CT scan.
1. Cheap
2. Quick
3. Can determine need for further imaging like CTA or MRI
infection or tumors
Just like the CT, an MRI with contrast is used to detect infection or tumors. An MRI is much better for looking at ______________. It is the best test for ____________ and _____________.
In T1, water appears _____________ while in T2 it appears _______________.
soft tissue
brain, spine
dark, light
The Monroe kellie doctrine states that the skull has a certain volume and if we had more volume to that “fixed box” then the pressure begins to rise. Normal ICP is _________________ and we start to get concerned when the ICP is __________________
7-15= normal
20-25= concern
What are the focal symptoms that are present in someone with elevated ICP
AMS, pupil abnormalities, loss of cough or gag reflex
The goal of elevated ICP is to reduce it in the least invasive way possible. How is it managed?
- Maintain HOB at 30, neck in good alignment
- steroids for edema from tumors, mannitol to draw fluid out of the brain
- Hyperventilation to decrease CO2 from causing vasoconstriction and decreasing cerebral blood flow (LAST RESORT BC ISCHEMIA)
- Ventricular drain to drain CSF and reduce volume in the skull
- Decompressive hemicraniectomy - remove piece of skull
_______________ are the most common type of primary CNS tumor. It is an abnormal growth of the meninges, specifically the ________________, covering the brain and spinal cord. This is more common in women and men and the median age of diagnosis is 65.
meningioma
arachnoid
There are numerous types of gliomas and they are named based on the cell line which is malignant. ________________ is the most common type. _____________________ is not a particular type of tumor, it is a term used to describe a high grade glioma
astrocytoma
glioblastoma multiforme
__________________ brain tumors are the most frequent type of tumors to arise in the brain. ______________ is the most frequent met followed by breast and melanoma. ___________ and _____________ are the most common mets for the spine.
mets
lung
lung
breast
What are the risk factors for meningiomas?
advanced age
ionizing radiation exposure
genetics
obesity
What are the risk factors for metastatic tumors?
smokers > lung ca
higher risk of brain mets in older patients with cancer
small cell lung CA has a high propensity of metastasizing to the brain
What are the risk factors for gliomas?
advanced age
radiation exposure
What is the most common presenting symptoms for patients with brain tumors? What are some others associated with brain tumor?
headache
seizures, altered neurological status (change in speech, memory, affect or confusion)
What are the symptoms of a frontal lobe tumor?
hemiparesis, aphasia, gait dysfunction, personality change
What are the symptoms of a parietal lobe tumor?
contralateral sensory or motor dysfunction, homonymoous neglect, aphasia for dominant lobe. dominant lobe is left side for most people lefties have a slightly higher rate of right brain dominance
What are the symptoms of a temporal lobe tumor?
auditory or perceptual changes, memory loss, aphasia for dominant lobe tumors
What are the symptoms of an occipital lobe tumor?
dysfunction of eye movement, homonymous hemianopsia, cortical blindness for bilateral tumors.
What are the symptoms of a cerebellar tumor?
loss of coordination, equilibrium, severe vertigo, dysmetria, obstructive hydrocephalus can occur quickly
For patients with new diagnosis of intra-parenchymal brain tumor, utilize ___________________________ to asses for metastatic disease.
CT chest/abd/pelvis
Brain abscess can mimic _______________ on MRI
tumors
Management of brain mets
For patients with evidence of malignancy in the body and brain proceed with ________________ of the most available lesion.
Large solitary tumors can be treated with _________________ and _________________
__________________ is commonly utilized as primary treatment.
For diffuse, > 3, tumors, _____________________ is the treatment of choice. However, this could cause more side effects such as nausea/vomiting, hair loss and cognitive decline.
biopsy
craniotomy, tumor resection
radiation
whole brain radiation
Meningiomas arise from the _______________ layer of the meninges.
They are graded I- III
Grade 1: ______________________
Grade 2: _______________________
Grade 3: ________________________
Grade II or III lesions often have more aggressive features on MRI such as __________________________
They are largely ___________________ but can still exert pressure on surrounding brain as they grow.
Most are found incidentally.
arachnoid
benign
atypical
malignant
surrounding cerebral edema
non-malignant
What is the management of meningiomas?
What are complications?
neurosurg
- watch with MRI 6mo - 1 yr after initial scan. Image every 3 years and then every 2 years for roughly 10 years. most pts WONT develop sx
craniotomy for larger lesions or those causing sx
-typically repeat MRI 3-6 months later to assess for residual tumor
complications: acute neurological injury due to bleeding or stroke
WHO Grades gliomas from 1-4 based on histological and molecular features.
Grade 1-2 are commonly called __________________.
Grade 3-4 are commonly called ___________________.
low grade glioma
high grade glioma
- What are high grade gliomas?
- What are the most common presenting symptoms?
- Gliomas are grouped by genetic and molecular factors such as
- 2.
- they are malignant and often rapidly progressive, primary brain tumors. They were formerly labeled as glioblastoma multiforme or GBM.
- the most common presenting symptoms are headache, seizure, focal neurological deficits which are more common with these types of tumors than any other.
- IDH mutation, methylation
- What are low grade gliomas?
- Do patients with low grade gliomas present with focal neurological deficits?
With time, what will low grade gliomas transform to?
- less aggressive than high grade they grow slowly and less invasion into the brain means less cerebral edema.
- it is LESS likely. they often still present with headaches or seizures.
they will transform to high grade tumors.
What is the management for gliomas?
after discovery, neurosurg and radiation oncology
high grade gliomas have a lot of edema, treated with steroids, dexamethasone
keppra is used for seizure prophylaxis
for tumors that are accessible, the initial treatment is craniotomy for surgical resection then adjuvant therapy
temodar is the primary chemo agent for treatment of GBM
for low grade gliomas= gross total resection
Complications and prognosis of gliomas.
Like most CNS tumors, complications of gliomas involve ____________ or _______________ in the area of the tumor. The average survival of GBM is 12-18 months and for low grade it is 5-10 years but remains incurable.
bleeding, infarct
Intramedullary tumors arise within the ________________. They are usually caused by ________________ or __________________.
These tumors cause
1.
2.
3.
4.
What is the treatment?
spinal cord.
ependymomas or astrocytoma
- radicular pain
- numbness/tingling
- spasticity
- loss of pain or temp sensation
tx: steroids
Intradural extramedullary tumors arise within the _______________ but outside of the _________________.
1
2
3
being the most common
Tx is often through _____________ though risk of CSF leak is elevated and ____________
dura, spinal cord.
meningiomas, nerve sheath tumors, schwannoma
tx: resection, +/- radiation
Extradural lesions are usually metastatic lesions arising from the __________________. Most common form of tumor involving the spine and spinal cord.
1
2
3
are the most common malignancies to spread to the spine
spine,
lung, breast, prostate CA
What two signs are common indicators for spinal disease?
clonus and hoffmans
________________ lesions can cause symptoms in the UE and LE, _______________ or ________________ WONT affect the UE
cervical, thoracic, lumbar
______________ is a term used to describe the symptoms caused by spinal cord compression caused by degenerative disease or cancer.
myelopathy
Patients with spine metastasis typically present with __________________ though radicular pain and neurological deficits are not uncommon
Treatment: ________________ can improve radicular pain and reduce symptoms caused by nerve compression by mitigating cord edema.
for patients with acute neurological deficits urgent ______________ and ____________ is needed to preserve neurological function.
A stable spine with mild neurological symptoms can be treated with ______________ to the lesion.
back pain
steroids
decompression and fusion
radiation
- What are nerve sheath tumors?
- Which ones are most common?
Cutaneous neurofibromas involve more __________________ within the skin. Neurofibromatosis is a diffuse growth of neurofibromas
- largely benign tumors that arise from the nerve sheath.
- schwannomas and neurofibromas are most common but all together these are rare.
peripheral nerve tissue
