CNS Tumors/ Basal Ganglia Flashcards
What is the difference between a primary and secondary tumor?
primary originate in the CNS
secondary– metastasize from sites outsides the CNS
description of benign tumors
slow growing
does not spread
does not invade tissue
description of malignant tumors
fast growing
spreads
invades tissues
Grade I tumors
benign
slow-growing, low proliferative potential
associated with long-term survival
Grade II tumors
benign or malignant
relatively slowly-growing, low proliferation, but sometimes recur as higher grade tumors
prognosis: typically survive more than 5 years post-diagnosis
Grade III tumors
Malignant and often recur as higher grade tumors
treatment includes radiation or chemotherapy
prognosis: survive 2-3 years post-diagnosis
Grade IV tumors
reproduce rapidly and are very aggressive malignant tumors
mitotically active disease
prognosis: is usually fatal (examples include glioblastoma); majority of individuals with glioblastoma succumb to disease within the year, whereas medulloblastoma with treatment has a 5-year survival rate
Tumors of neuroepithelial tissue
astrocytomas
oligodendrogliomas
primitive neuroectodermal tumors (PNET)
tumors of meninges
meningiomas
Tumors of cranial and paraspinal nerves
Schwannoma (vestibular)
Metastatic Tumors
Metastatic (secondary) tumors
Astrocytomas
most common primary brain tumor in adults
young adults (most often frontal lobe) and Children (most often cerebellum)
Classified via 1-4 grading scale
-pilocytic astrocytoma (grade I): 30-40 y/o, benign, form cysts, slow growing
-low grade astrocytoma (grade II): 30-40 y/o, benign, form cysts, slow growing
-Glioblastoma Multiforme (Grade IV): highly malignant, rapid growth, <20% survival past 1 year: most common adult brain neoplasm)
oligodendrogliomas
- majority of oligodendrogliomas present in young adulthood with onset of seizures and headaches due to electrical conductivity problems
- typically slow-growing, supratentorial
- can have long-term survival– median 9 years, 60-75% 5-year survival
Primitive Neuroectodermal Tumors (PNET)
- arise from primitive, undifferentiated nerve cells from the gestational development of the nervous system
- most common malignant CNS tumor in children: Medulloblastoma (arise in 4th ventricle between brain stem and cerebellum)
- increased intracranial pressure (ICP):
- typically first symptoms detected
- classic triad: morning headache, vomiting , lethargy
- cerebellar impairments: progressively worsening ataxia
- brain stem impairments
- multiple cranial nerve findings: diplopia, facial weakness, tinnitus, hearing loss, head tilt, stiff neck
Schwannoma (vestibular) tumors
-formerly known as acoustic neuromas
-arise from vestibular nerve sheath of CN VIII
-benign, slow growing
-usually unilateral
-impairments arise from compression of CN VIII
-tinnitus
-relatively rapid progression of sensorineural hearing
loss
-facial numbness when tumor reaches ~ 2.5 cm diameter
-ataxia, if reaches cerebellum
Meningioma
-most common primary, intracranial tumor of non-glial origin
-typically solitary, benign, slow-growing, highly vascular (arise from arachnoid granulations)
-most common in between 30s-60s
-women> men 2:1
common symptoms/impairments:
-focal weakness
-headache
-seizures (imbalance of peritumoral tissue pH, ion concentrations, amino acid balance)
-eventual increase of IP if untreated
-mental status changes
All symptoms depend on FOCAL area affected
Metastatic tumors
Occur is 20-40% of people with a primary CA elsewhere in the body
Cancers that frequently spread to the brain (lung, breast, colon, kidney)
treatment of solitary lesions is surgical resection followed by radiation therapy
Components of Basal Ganglia
Caudate nucleus putamen globus pallidus subthalamic nucleus substantia nigra
Basal Ganglia
Act as “way station” taking information, integrating it for complex modulation of motor behaviors and projecting back out to cortex for motor output
Where is Dopamine produced?
substantia nigra
What are the two main feedback systems for refining motor system output?
basal ganglia
cerebellum
Function of motor loop
Roles of motor loop
links putamen, globus pallidus, and ventral lateral thalamic nucleus to the motor and premotor cortex
Roles: movement selection and action, regulating muscle contraction, force, multi-joint movements, and sequencing
Basal ganglia motor circuit regulates…
muscle contraction muscle force multi-joint movements sequencing movements *No direct output to LMNs, so works via motor thalamus, pedunctulopontine nucleus, and midbrain locomotor region*
Hypokinetic disorders
= excessive inhibition
Parkinson’s Disease
Hyperkinetic disorders
= inadequate inhibition Huntington's Dystonia Tourette's Dyskinetic cerebral palsy
indicators of a diagnosis other than PD
early postural unsteadiness rapid progression of signs respiratory dysfunction abnormal postures emotional lability cerebellar signs corticospinal dysfunction voluntary gaze dysfunction
symptoms of progressive supranuclear palsy
therapy options for progressive supranuclear palsy
- early onset gait unsteadiness with tendency to fall backward
- axial rigidity
- freezing of gait
- apathy
- depression
- slowed thinking
- psychosis
- rage attacks
- involuntary eye closing
- dysarthria
- dysphagia
- supranucelar gaze palsy
prism glasses, strength, flexibility, posture, balance, mobility, weighted walkers and heel wedges
multiple system atrophy
therapy options for multiple system atrophy
progressive degenerative disease affecting basal ganglia, cerebellar, and autonomic systems, peripheral nervous system, and cerebral cortex.
- akinetic/rigid syndrome
- cerebellar signs (dysarthria, truncal/gait ataxia
- autonomic dysfunction (hyoptension, B&B, decrease sweating/tears/saliva, impotence
- corticospinal tract dysfunction (motor function, UMN signs)
therapy: strength, fitness, education (offset hypotension w/ slow position changes, avoid prolonged standing, use compression, avoid warm temps)
Lewy Body Dementia
therapy options for LBD
lewy bodies = abnormal accumulations of proteins within neurons
- early, generalized cognitive decline
- visual hallucinations
- motor signs indistinguishable from postural instability gait difficulty subtype of PD
therapy: exercise for strengthening, fitness, balance, etc. as with PD
drug-induced parkinsonism
bilateral onset with rapid progression, early postural tremor, involuntary facial movement
chronic traumatic encephalopathy (CTE)
victims of abuse, epilepsy, military, athletes (repeated head trauma)
huntington’s disease
characterized by chorea (involuntary, jerky movements) and dementia
- inherited, progressive
- onset 40-50 years of age
- causes degeneration in the brain, decreasing signals from the basal ganglia
- disinhibition of the motor thalamus and the PPN -> excessive output from motor areas of the cerebral cortex
therapy: education, fall prevention, assistive technology, HEP
