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Neuro > CNS Tumors - Exam 3 > Flashcards

CNS Tumors - Exam 3 Flashcards

1
Q

_____ is responsible for personality characteristics, decision making,
voluntary muscle movement, speech production, short term memory

A

frontal lobe

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2
Q

_____ lobe is responsible for the sense of touch and interpretation of objects and space

A

Parietal

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3
Q

_____ lobe is responsible for short and long-term memory, understanding of speech,
hearing and emotions

A

temporal lobe

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4
Q

____ lobe is responsible for visual sense and interpretation

A

occipital lobe

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5
Q

____ lobe is responsible for coordination, balance and equilibrium

A

cerebellum

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6
Q

Cranial nerves _____ through ____ all arise from the brainstem

A

3-12 all arise from the brainstem

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7
Q

Symptoms of a CNS tumor will reflect one of 3 pathological processes. What are they? How do the symptoms present?

A

Functional area of the brain involved

Compression of adjacent structures

Increased intracranial pressure

insidious in onset and can be general or focal

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8
Q

Generalized symptoms of a CNS tumor often present like _______

A

increased intracranial pressure

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9
Q

_____ is the most common manifestation of brain tumors and is often the worst symptom– occurs in 50% of patients. Describe them

A

HA

HA’s are often nonspecific and resemble tension-type headaches (40-80%) or migraines

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10
Q

What are the characteristics of a HA that is consistent with a CNS tumor?

A

dull, constant ache, occasional throbbing

bifrontal with increased pain on the same side of the tumor

progresses over time

pain increases with change in body position or any raises in ICP

pain at night or pain that wakes you up from sleep

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11
Q

**What are the red flag symptoms associated with HA?

A
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12
Q

What is the N/V associated with CNS tumors due to? What can trigger them that would make you think it is due to CNS tumor?

A

due to increased ICP

Emesis triggered by abrupt change in body position

Neurogenic emesis – emesis present with other neurological symptoms such as headache or neuro deficits

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13
Q

HA
N/V
Altered Level of Consciousness/Syncope
seizure
neurocognitive dysfunction

What am I?

A

CNS tumor

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14
Q

In CNS tumors, what is the Altered Level of Consciousness/Syncope due to? What is it triggered by?

A

Significant rise in ICP can lead to a loss of cerebral perfusion resulting in diminished and loss of consciousness

Triggered by position change or activities that further increase ICP

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15
Q

Syncope due to increased ICP may results in ______

A

seizure activity

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16
Q

_____ are one of the most common symptoms in primary and metastatic tumors. What do these depend on?

A

Focal seizures

intensity, type and frequency depends on the location of the tumor

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17
Q

What lobe? _____ focal tonic-clonic movements involving one extremity, inability to perform cognitive tasks

A

Frontal lobe

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18
Q

What lobe? _____ visual disturbances

A

occipital lobe

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19
Q

What lobe? ______ abrupt behavioral/memory changes with or without aura

A

temporal lobe

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20
Q

What lobe? _____ sensory seizures
auditory and/or tactile hallucinations or numbness in a part of the body

A

parietal lobe

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21
Q

What are focal symptoms clinical presentation based on?

A

functional location of tumor or compression of surrounding structures

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22
Q

What lobe?
Personality changes
Progressive intellectual decline
Difficulty with concentration and memory
Expressive aphasia
anosmia
contralateral weakness

A

frontal lobe

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23
Q

What is expressive aphasia? What region of the brain?

A

Word finding hesitation or word substitutions

able to think clearly but not able to expressive themselves verbally

Broca’s region

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24
Q

What is anosmia? What part of the ____ lobe?

A

the partial or total loss of the ability to smell due to pressure on the olfactory nerve

base of the frontal lobe

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25
Q

Sensory seizures: tactile hallucinations
Contralateral disturbances of sensation: loss of sensation that is NOT consistent with dermatomes
astereognosis
Visuospatial deficit, R/L awareness

What lobe?

A

Parietal Lobe Lesions

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26
Q

Homonymous hemianopia
Loss of color perception
Sensory seizure- visual hallucinations
Prosopagnosia
Visual Simultagnosia

What lobe?
What is Prosopagnosia?
What is Simultagnosia?

A

occipital lobe

Prosopagnosia: Inability to recognize a familiar face

Simultagnosia: Inability to integrate and interpret a composite scene as opposed to its individual elements

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27
Q

Olfactory (smell) or gustatory (taste) hallucinations
Auditory illusions or hallucination
Motor phenomena such as licking or smacking of the lips
Depersonalization, emotional or behavioral changes
Sensations of déjà vu
long-term memory impairment
Lack of language comprehension (Wernicke’s)

What lobe?
What is the difference between illusions or hallucinations?

A

temporal

illusion have stimulus and hallucinations do NOT have a stimulus

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28
Q

Cranial nerve palsies (III - XII)
Ataxic gait
Nystagmus
Altered reflexes

Where is the lesion?

A

brainstem

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29
Q

Marked ataxia of the trunk
Incoordination and hypotonia of the limbs

Where is the lesion?

A

cerebellar lesion

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30
Q

What is the classic triad of ICP?

A

headache, nausea/vomiting, and papilledema

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31
Q

What are 3 pathophysiologic processes that result in ICP?

A

Large mass

Restriction of CSF outflow causing hydrocephalus

Disruption of the blood brain barrier by angiogenesis of the tumor leading to edema

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32
Q

What are 3 types of herniation due to ICP?

A

subfalcial

transtentorial/uncal

cerebellar-foramen magnum/tonsillar

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33
Q

a subfalcial herniation may occlude the _______ leading to _____ lobe infarction

A

anterior cerebral artery

frontal

position 1

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34
Q

a transtentorial/uncal herniation compresses _______, midbrain and ________. What does it lead to?

A

compression of CN III

posterior cerebral artery

Leads to ipsilateral pupillary dilation, followed by stupor, coma, decerebrate posturing, and respiratory arrest

aka a unilateral blown pupil is NOT GOOD

position 2

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35
Q

Cerebellar–foramen magnum/tonsillar compression of the ______ causing apnea, circulatory collapse, and death

A

medulla

position 3

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36
Q

What is the imaging of choice for a CNS tumor? Why is it better?

A

MRI Brain with contrast (gadolinium)

Detects the lesion and defines its location, shape, and size. Can detect normal anatomy distortion. demonstrates the degree of any associated cerebral edema or mass effect

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37
Q

What are the CI for a brain MRI? What is the next best option?

A

metallic implants, embedded devices, or uncontrolled claustrophobia

CT scan with iodine

38
Q

A brain CT with contrast is not helpful in detecting _______ or _____ lesions

A

unable to detect small lesions or those in the posterior fossa

39
Q

When is a MR spectroscopy indicated? How does it work?

A

indicated in tumors that do not enhance on MRI with contrast

Measures biochemical changes (chemical metabolism) in the brain and compares it to the chemical composition of the normal brain tissue. Tissue activity is plotted on a graph with varying heights

40
Q

What is the management for a pt with a CNS tumor? How do you determine urgent vs outpt?

A

refer to neurosx!!

urgent: large, symptomatic tumors - signs of increased ICP or impending herniation

outpt: smaller tumors and those with minimal symptoms

41
Q

What do you do pharm management wise for a CNS tumor?

A

Dexamethasone-> to reduce seizures

if the pt has had a seizure: start AED medications (levetiracetam (Keppra), topiramate (Topamax), lamotrigine (Lamictal), valproic acid, and lacosamide (Vimpat))

42
Q

What antiseizure drugs do you want to avoid in a pt with a CNS tumor?

A

AVOID phenytoin and fosfphenytoin

43
Q

**What is MORE IMPORTANT for a pt with a CNS tumor that is showing s/s of an impending herniation or midline shift?

A

**secure an airway!!!

super important that this gets done ASAP

44
Q

What are the generic tx options for CNS tumors?

A

Surgical excision

Radiation - main treatment if needed after resection

Chemotherapy

Symptomatic therapy: Corticosteroids, Anticonvulsants

Palliative care

45
Q

What are glial cells? What are the 4 types of CNS glial cells?

A

Glial cells are supportive cells located around the axon but do not transmit electrical impulses

Astrocyte
Oligodendrocytes
Ependymal cells
Microglia

46
Q

What type of glial cell? _______ have numerous projections that link neurons to their blood supply while forming the blood-brain barrier

A

astrocyte

link neurons to their blood supply

47
Q

What type of glial cell? _______ create myelin which forms the myelin sheath around the axon

A

Oligodendrocytes

create myelin

48
Q

What type of glial cell? _______ line the spinal cord and the ventricular system of the brain. They secrete CSF and beat their cilia to help circulate the CSF and make up the blood-CSF barrier

A

Ependymal cells

secrete CSF and beat their cilia to help circulate the CSF

49
Q

What type of glial cell? _______ clear cellular debris and dead neurons from nervous tissue through phagocytosis

A

microglia

clear cellular debris and dead neurons

50
Q

What are the 2 types of PNS glial cells?

A

Schwann cells

Satellite cells

51
Q

What type of PNS cell? ________ provide myelination to the axons of the PNS
have phagocytic activity, clearing cellular debris allowing regrowth of PNS neurons

A

Schwann cells

provides myelination and have phagocytic activity

52
Q

What type of PNS cell? ________ surround (and protect) neuron cell bodies in sensory, sympathetic, and parasympathetic ganglia. Highly sensitive to injury and inflammation. Regulate the external chemical environment
Provide nutrients to the neuron

A

satellite cells

53
Q

What are the 4 responsibilities for a satellite cell?

A

surround (and protect) neuron cell bodies in sensory, sympathetic, and parasympathetic ganglia

Highly sensitive to injury and inflammation and contribute towards chronic pain syndromes

Regulate the external chemical environment

Provide nutrients to the neuron

54
Q

_____ cells are highly sensitive to injury and inflammation and contribute towards _______

A

satellite cells

chronic pain syndromes

55
Q

What are the 2 classifications of CNS tumors?

A

primary: arises from nothing aka originated in the brain

metastatic tumor: MC- come from a cancer somewhere else in the body

56
Q

What is the MC type of metastatic tumor that travels to the brain? give 4 more

A

lung- MC

breast, melanoma, renal and colorectal

57
Q

What is the only known risk factor for CNS tumor? ______ and _____ are at the highest risk

A

Exposure to ionizing radiation is the only known risk factor

Therapeutic radiation and atomic bomb survivors are at highest risk

58
Q

with regards to diagnostic radiation, ____________ is a risk factor for a CNS tumor. When will they typically present?

A

Diagnostic radiation: head CT exposure in children

usually as early as 5 years after exposure

59
Q

_______ increases your risk for CNS lymphoma

A

immunosuppression

60
Q

What is the grading of CNS tumors based on? What is the scale?

A

cell differentiation and aggressiveness (mitotic figures, necrosis, vascular proliferation)

Grade I-IV: 1 is least aggressive and IV is most aggressive

61
Q

What are the 3 different kinds of MALIGNANT CNS tumors? Which one is MC?

A

Gliomas- MC

Medulloblastoma

Primary CNS lymphoma

62
Q

What are the 3 different types of gliomas? Are these malignant or benign? Where can they occur?

A

astrocytomas
oligodendrogliomas (ODs)
ependymomas

all are malignant

brain or spinal cord

63
Q

What is the only benign type of CNS tumor?

A

Meningioma

64
Q

**WHO grade III will have the word _______ in the name

A

“anaplastic”

65
Q

**WHO grade IV will either start with ______ or end with ________

A

“Glio” or “-blastoma”

66
Q

What is the most aggressive type of astrocytoma?

A

Glioblastoma

67
Q

______ is the MC type of glioma that is common in young children

A

Ependymomas

68
Q

What is the management for glioma WHO grade I and II? **What are the 2 criteria/risk factors for observation as the next step?

A

complete surgical resection

NEED BOTH in order to qualify for observation:
less than 40 and clean margins on bx

69
Q

If 1 of the risk factors are present with regards to WHO I and II management after bx, what is the next step? then what is next?

A

radiation followed by chemotherapy

monitor for relapse: if occurs: sx, chemo and radiation

70
Q

What is the management for WHO III and IV?

A

Maximal, safe resection with concurrent chemoradiotherapy

consider clinical trials!!!!

71
Q

______ is the MC malignant brain tumor in children. What is another name for it? Where does it originate?

A

Medulloblastoma

cerebellar primitive and neuroectodermal tumor (PNET)

cerebellum (posterior fossa)

72
Q

What is the management for a Medulloblastoma? What is the survival rate?

A

Surgical resection
Chemotherapy
Radiation therapy

75% of pts survive into adulthood

73
Q

_______ is MC associated with immunodeficiency states. If one is not obviously present, what do you need to do?

A

Primary CNS Lymphoma

need to go find the source!! aka need to test for some immunodeficiency states

74
Q

in primary CNS lymphoma, need to order CSF analysis to rule out Ddx of _______ in immunocompromised patients

A

toxoplasmosis

75
Q

What is the management for primary CNS lymphoma?

A

glucocorticoids

chemo

radiation

76
Q

in primary CNS lymphoma, want to avoid giving ______ if possible because it will interfere with the histology results. When should you give it?

A

glucocorticoids

but need to give if you suspect herniation, midline shift or edema!!!!

77
Q

______ is the 2nd MC primary CNS tumor. What is it?

A

Meningioma

A tumor that develops on the dura mater or arachnoid mater

78
Q

What is the WHO grading system for Meningiomas? What is causing the s/s?

A

I is benign
II is “atypical”
III is malignant

Symptoms occur due to compression of surrounding neural structures and size

79
Q

What is considered small in a meningioma? What is the tx?

A

Small (<2 CM) asymptomatic

tumors may be conservatively managed with observation and repeat MRI in 3-6 months. If growth consider surgery vs irradiation

80
Q

What is the management for Grade II and III meningiomas?

A

Grade II and III tumors require wide resection of tumor margins

81
Q

What cancers are the MC to spread to the brain? Which one has the highest propensity to spread to the brain?

A

lung** MC, breast, melanoma, renal, colorectal

melanoma has the highest propensity

82
Q

What is the management for a metastatic CNS tumor? **Is bx necessary? Do s/s tend to progress more rapidly or slowly?

A

glucocorticoids, radiotherapy, chemotherapy and palliative surgery

**Biopsy is usually not necessary

progress more rapidly than primary tumors

83
Q

What are the 3 kinds of spinal cord tumors?

A

intramedullary

intradural-extramedullary

extradural

84
Q

What is the MC type of cancer found in the intramedullary spinal cord?

A

gliomas specifically -> ependymomas are the MC spinal glioma

85
Q

What type of CNS tumors are found in the Intradural-extramedullary location of the spinal cord?

A

meningiomas

nerve sheath tumors: Schwannoma, neurofibroma

86
Q

What kinds of metastatic cancers tend to spread into the extradural location of the spinal cord?

A

prostate, breast and lung

87
Q

What are some pathophys reasons behind the s/s seen with spinal cord tumros?

A

Direct compression of neurologic structures

Ischemia secondary to arterial or venous obstruction

Invasive infiltration

88
Q

Localized pain - wakes nocturnally - gnawing and unremitting
Sensory dysesthesias and muscular weakness
may start unilaterally but progresses to bilateral involvement
Bladder, bowel and sexual dysfunction may occur
Progressive difficulty in ambulation

What am I?
What is the imaging of choice?
What is the management?

A

spinal cord tumor

tx: MRI spine with contrast

management:
glucocorticoids
surgical decompression/removal
radiotherapy

89
Q

What is the SPIKES model for delivering bad news? just read the slide a couple times and you should be fine

A
90
Q
A

Neuro (13 decks)

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