CNS Tumors

Question 1

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 ___________

Answer 1

CT scan.
1. Cheap
2. Quick
3. Can determine need for further imaging like CTA or MRI

infection or tumors

Question 2

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 _______________.

Answer 2

soft tissue
brain, spine

dark, light

Question 3

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 __________________

Answer 3

7-15= normal
20-25= concern

Question 4

What are the focal symptoms that are present in someone with elevated ICP

Answer 4

AMS, pupil abnormalities, loss of cough or gag reflex

Question 5

The goal of elevated ICP is to reduce it in the least invasive way possible. How is it managed?

Answer 5

1. Maintain HOB at 30, neck in good alignment
2. steroids for edema from tumors, mannitol to draw fluid out of the brain
3. Hyperventilation to decrease CO2 from causing vasoconstriction and decreasing cerebral blood flow (LAST RESORT BC ISCHEMIA)
4. Ventricular drain to drain CSF and reduce volume in the skull
5. Decompressive hemicraniectomy - remove piece of skull

Question 6

_______________ 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.

Answer 6

meningioma
arachnoid

Question 7

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

Answer 7

astrocytoma

glioblastoma multiforme

Question 8

__________________ 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.

Answer 8

mets
lung
lung
breast

Question 9

What are the risk factors for meningiomas?

Answer 9

advanced age
ionizing radiation exposure
genetics
obesity

Question 10

What are the risk factors for metastatic tumors?

Answer 10

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

Question 11

What are the risk factors for gliomas?

Answer 11

advanced age
radiation exposure

Question 12

What is the most common presenting symptoms for patients with brain tumors? What are some others associated with brain tumor?

Answer 12

headache
seizures, altered neurological status (change in speech, memory, affect or confusion)

Question 13

What are the symptoms of a frontal lobe tumor?

Answer 13

hemiparesis, aphasia, gait dysfunction, personality change

Question 14

What are the symptoms of a parietal lobe tumor?

Answer 14

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

Question 15

What are the symptoms of a temporal lobe tumor?

Answer 15

auditory or perceptual changes, memory loss, aphasia for dominant lobe tumors

Question 16

What are the symptoms of an occipital lobe tumor?

Answer 16

dysfunction of eye movement, homonymous hemianopsia, cortical blindness for bilateral tumors.

Question 17

What are the symptoms of a cerebellar tumor?

Answer 17

loss of coordination, equilibrium, severe vertigo, dysmetria, obstructive hydrocephalus can occur quickly

Question 18

For patients with new diagnosis of intra-parenchymal brain tumor, utilize ___________________________ to asses for metastatic disease.

Answer 18

CT chest/abd/pelvis

Question 19

Brain abscess can mimic _______________ on MRI

Answer 19

tumors

Question 20

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.

Answer 20

biopsy

craniotomy, tumor resection

radiation

whole brain radiation

Question 21

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.

Answer 21

arachnoid

benign

atypical

malignant

surrounding cerebral edema

non-malignant

Question 22

What is the management of meningiomas?

What are complications?

Answer 22

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

Question 23

WHO Grades gliomas from 1-4 based on histological and molecular features.
Grade 1-2 are commonly called __________________.
Grade 3-4 are commonly called ___________________.

Answer 23

low grade glioma
high grade glioma

Question 24

1. What are high grade gliomas?
2. What are the most common presenting symptoms?
3. Gliomas are grouped by genetic and molecular factors such as
4. 2.

Answer 24

1. they are malignant and often rapidly progressive, primary brain tumors. They were formerly labeled as glioblastoma multiforme or GBM.
2. the most common presenting symptoms are headache, seizure, focal neurological deficits which are more common with these types of tumors than any other.
3. IDH mutation, methylation

Question 25

1. What are low grade gliomas?
2. Do patients with low grade gliomas present with focal neurological deficits?

With time, what will low grade gliomas transform to?

Answer 25

1. less aggressive than high grade they grow slowly and less invasion into the brain means less cerebral edema.
2. it is LESS likely. they often still present with headaches or seizures.

they will transform to high grade tumors.

Question 26

What is the management for gliomas?

Answer 26

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

Question 27

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.

Answer 27

bleeding, infarct

Question 28

Intramedullary tumors arise within the ________________. They are usually caused by ________________ or __________________.

These tumors cause
1.
2.
3.
4.

What is the treatment?

Answer 28

spinal cord.
ependymomas or astrocytoma

1. radicular pain
2. numbness/tingling
3. spasticity
4. loss of pain or temp sensation

tx: steroids

Question 29

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 ____________

Answer 29

dura, spinal cord.

meningiomas, nerve sheath tumors, schwannoma

tx: resection, +/- radiation

Question 30

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

Answer 30

spine,
lung, breast, prostate CA

Question 31

What two signs are common indicators for spinal disease?

Answer 31

clonus and hoffmans

Question 32

________________ lesions can cause symptoms in the UE and LE, _______________ or ________________ WONT affect the UE

Answer 32

cervical, thoracic, lumbar

Question 33

______________ is a term used to describe the symptoms caused by spinal cord compression caused by degenerative disease or cancer.

Answer 33

myelopathy

Question 34

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.

Answer 34

back pain

steroids

decompression and fusion

radiation

Question 35

1. What are nerve sheath tumors?
2. Which ones are most common?

Cutaneous neurofibromas involve more __________________ within the skin. Neurofibromatosis is a diffuse growth of neurofibromas

Answer 35

1. largely benign tumors that arise from the nerve sheath.
2. schwannomas and neurofibromas are most common but all together these are rare.

peripheral nerve tissue