CNS Tumors

Question 1

Primary brain tumors in adults vs children?

Answer 1

Adults supratentorial, children infratentorial

Question 2

Glial tumors

Answer 2

Astrocytoma, Ependymoma, Oligodentroglioma

Question 3

Non glial tumors

Answer 3

Neural progenitor origin
Meningioma
Pituitary adenoma

Question 4

Astrocytoma

Answer 4

20% of neoplasms, life expectancy 5 years.
4 grades, the worst is GBM. If lower grade, can undergo malignant transformation
Best option is complete resection, but can’t resect GBM

Question 5

Astrocytoma grades

Answer 5

I: Fibrillary astrocytoma
II: Astrocytoma/oligodendroglioma
III:Anaplastic Astrocytoma
IV: Glioblastoma multiforme

Question 6

Can a brain tumor have variable pathology in different parts?

Answer 6

Yes, but pathology is officially the most malignant portion

Question 7

Treatment for GBM

Answer 7

Whole brain radiotherapy, if low grade, resection

Question 8

Oligodendroglioma

Answer 8

5% of glial tumors, present in middle aged females

Can cause frontal lobe seizures. Can debulk and add radio/chemotherapy

Question 9

Ependymoma

Answer 9

5% of glial cell neoplasms, usually located in the posterior fossa. Most frequently in children/young adults, and can sometimes seed down into the spinal fluid.

Question 10

Most common intrinsic tumor of the spinal cord?

Answer 10

Ependymoma

Question 11

Choroid plexus tumors

Answer 11

Cause hydrocephalus by secreting too much CSF. Most common between birth and 10 years. Most common in IV ventricle

Question 12

Meningioma

Answer 12

Second most common primary intracranial neoplasm, tumor is external to brain and displaces tissue. More common in women after age 40. Can be induced by radiation therapy.

Question 13

Treatment of meningiomas

Answer 13

Usually not radiosensitive, so surgery or no treatment

Question 14

Acoustic Neuroma

Answer 14

Schwannoma that cause tinnitus, deafness, compression of other cranial nerves. Surgery is curative. NF2 (neurofibromatosis)

Question 15

Pituitary adenoma

Answer 15

Can cause acromegaly or gigantism, prolactinoma most common, then GH.

Question 16

Primary cerebral lymphoma

Answer 16

Steroid sensitive, but poor outcome

Question 17

Brain metastases

Answer 17

Occur in 20-30% of those with systemic cancer because 15-20% of blood goes to brain.

Question 18

Most common brain mets?

Answer 18

Lung, breast, melanoma

Question 19

Most common herniation syndrome?

Answer 19

Subfalcine herniation, doesn’t really have too much symptomatology, but sometimes contralateral leg weakness.

Question 20

Uncal herniation causes?

Answer 20

Dilated and unreactive pupil on affected side, LOC, contralateral OR ipsilateral (due to Kernohan’s notch) hemiparesis.

Question 21

Kernohan’s notch?

Answer 21

Uncal herniation can also cause ipsilateral hemiparesis because it pushes midbrain over and is compressed on the other side.

Question 22

Tonsillar herniation causes?

Answer 22

Cardiac and breathing malfunction.

Question 23

Vasogenic edema?

Answer 23

BBB becomes leaky, treat with steroids. Trauma/tumors

Question 24

Cytotoxic edema?

Answer 24

Problem with cells, can’t treat with steroids. Altitude sickness, pseudotumor cerebri.