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Neurology > CNS Tumors > Flashcards

CNS Tumors Flashcards

1
Q

MC brain tumors

A

mets from distant neoplasms

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2
Q

difference in location of brain tumors between adults and children

A

adults - supratentorial

children - infratentorial

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3
Q

ionizing radiation in therapeutic doses has been assoc. with which brain tumors?

A

meningiomas
astrocytomas
sarcomas

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4
Q

most common sx. of brain tumor

A

headaches
seizures (focal or generalized)
mental status changes - memory loss, lack of concentration, changes in personality, apathy

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5
Q

clinical presentation of brain tumor in children

A 
decreased appetite and weight loss
reduced school performance
dizziness
ataxia (gait)
neck pain
bulbar weakness
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6
Q

what can a ring-enhancing lesion on MRI mean?

A

mass lesion –> disruption of BBB by infiltrating neoplasm

BUT can also be seen in infections, subacute infarction, abscess, MS plaque, AVM, radiation necrosis

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7
Q

what test can be used to detect changes in brain tissue that are assoc. with the type and grade of tumor?

A

MR spectroscopy

- looks at peak of N-acetyl aspartate assoc. with neuronal loss

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8
Q

what are the 4 gliomas

A

astrocytoma
oligodendroglioma
ependymoma
choroid plexus papilloma

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9
Q

MC tumor in adults between 40-60 years old

A

glioblastoma multiforme (grade IV astrocytoma)

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10
Q

pathology seen in glioblastoma multiforme

A

highly malignant tumors with anaplasia, high cellularity, round/pleomorphic cells, nuclear atypia, vascular proliferation and necrosis

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11
Q

how do you differentiate between grade III and grade IV astrocytoma

A

grade IV has neovascularization and necrosis; they can also be mutlfocal and infiltrate brain widely

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12
Q

grade IV astrocytoma (GBM) on neuroimaging

A

solitary brain lesion (in deep white matter, BG or thalamus) with contrast enhancement, surrounding edema –> butterfly pattern

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13
Q

tx. regiment for GBM

A

surgical resection
radiation w/ concurrent temozolomide (cytotoxic alkylating agent) - continue this for 6 months
- consider nitrosurea drugs for combination therapy

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14
Q

how do you tx local recurrences of GBM

A

stereotactic radiosurgery and hmAb bevacizumab (sequesters VEGF)

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15
Q

what are the origins of low grade astrocytomas (I and II)

A

astrocytes (glial cells)

ependymal cells

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16
Q

in children, where do low grade astrocytomas occur

A

cerebellum

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17
Q

typical presentation of slow growing tumors

A

seizures

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18
Q

study of choice to dx glioma

A

MRI with contrast

- most lesions are bright on T2 and FLAIR

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19
Q

tx. for low grade gliomas (Astrocytoma I and II)

A

close observation with serial neuroimaging
surgery if total resection is possible
consider radiation/chemo

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20
Q

genetic signature of oligodendroglioma

A

codeletion of Xm arms 1p and 19q

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21
Q

common location of oligodendroglioma

A

frontal lobes, basal ganglia, thalamus

- usually have very SLOW growth

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22
Q

pathology features of oligodendroglioma

A

calcification

- perinuclear halos with swollen cytoplasm under microscopic

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23
Q

oligodendroglioma on neuroimaging

A

low intensity on T1, high intensity on T2
vasogenic edema uncommon
contrast enhancement = poor prognostic sign

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24
Q

tx of oligodendroglioma

A

total resection if possible
local radiation
PCV chemotherapy

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25
Q

PCV chemotherapy

A

procarbazine
lomustine
vincristine
- temozolomide used increasingly

26
Q

which tumor arises in spinal canal as intramedullary tumor in adults?

A

ependymoma

27
Q

in children, where are ependymomas located

A

intracranially in 4th ventricle

28
Q

histological hallmark of ependymomas

A

perivascular pseudorosettes - halo of cells surrounding central vascular lumen

29
Q

tx of ependymoma

A

surgery to decrease tumor burden followed by radiation and chemotherapy; recurrence rates are high so close follow up with MRI

30
Q

origin of meningioma

A

meningothelial (mesodermal) cells of dura mater

31
Q

common locations of meningioma

A

cerebral convexities, falx cerebri and sphenoid wing

32
Q

histology of meningioma

A

sheets of plump, uniform meningothelial cells with tendency to form whorls; P4 receptors found

33
Q

meningioma on MRI

A

isointense on T1 and T2 with intense contrast enhancement

calcifications seen on CT scan

34
Q

hyperostosis

A

osteoblastic reaction seen in CT/plain Xrays may indicate meningioma invasion of bone

35
Q

tx of meningioma

A

surgical removal (preceded with endovascular embolization)

36
Q

origin of medulloblastoma

A

primarily at medullary velum of 4th ventricle; primitive neuroectodermal tumor

37
Q

presentation of medulloblastoma

A

rapidly growing tumor that infiltrates surrounding tissue and extends toward 4th ventricle producing hydrocephalus and may spread via CSF intracranially and to spinal cord

38
Q

medulloblastoma on MRI

A

heterogenous contrast enhancing midline tumor compressing the 4th ventricle

39
Q

tx medulloblastoma

A

surgery plus radiation and chemo, steroids for vasogenic edema

40
Q

prognosis of medulloblastoma

A

poor prognosis in children with mets or subtotal resection; good prognosis with radical resection and radiation dose above 50 Gy to entire neuraxis

41
Q

acoustic schwannomas are MC among…

A

women

42
Q

common location of schwannomas

A

vestibular CN VIII in cerebellopontine angle, involving the facial and trigeminal nerves

43
Q

histology of schwannoma

A

sheets of uniform spindle cells, forming palisades called Verocay bodies

44
Q

tx of acoustic schwannoma

A

if sx, stereotactic radiosurgery (gamma knife) esp. if does not compress brain stem or is < 3 cm

45
Q

ganglioglioma

A

seen in children and young adults, mixture of neurons and glial cells
–> usually in cerebral hemisphere with slow growth and long duration of sx

46
Q

ganglioglioma on MRI

A

increased T2 signal with characteristic swollen gyri

47
Q

tx of ganglioglioma

A

surgery

48
Q

Tx of choice for Primary CNS lymphoma

A

high dose systemic MTX-based chemotherapy (along with cytarabine, temozolomide, rituximab) w/ wo radiation
- dramatic response to steroids, but tumor recurs within months

49
Q

MC distant neoplasms with mets to brain

A 
lung
skin - melanoma
kidney - renal cell ca
breast
colon
50
Q

where are mets usually localized to

A

gray-white junction and tend to be solitary but multiple are not unusual

51
Q

tx of brain mets

A

single lesions - resected followed by radiation

52
Q

drop metastases

A

intradural extramedullary spinal mets that arise from intracranial lesions (MCC is ependymomas or medulloblastomas)

53
Q

what test should be avoided with medulloblastoma

A

LP - unless CT shows no obstructive lesion to prevent cerebellar tonsillar herniation

54
Q

Nf2 associated tumors

A

bilateral vestibular schwannoma
meningiomas
intramedullary ependymomas

55
Q

brain mets that bleed easily

A

melanoma
renal cell carcinoma
choriocarcinoma

56
Q

low dose radiation therapy is assoc. with what brain tumors

A

meningiomas

gliomas

57
Q

children who receive radiation for primary tumors are at increased risk of?

A

secondary intracranial gliomas and sarcomas

58
Q

what two things increase risk of CNS lymphoma

A

HIV

post-transplant immunosuppression

59
Q

diagnostic test of choice for brain tumor evaluation

A

MRI with contrast

60
Q

most effective tx for malignant gliomas

A

radiation

61
Q

typical imaging characteristics of brain mets

A

smaller, multiple at grey-white junction at distal capillaries and assoc. with significant edema

Neurology (15 decks)

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