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Cancer, Palliative Care and Pain Medicine > CNS Tumours > Flashcards

CNS Tumours Flashcards

1
Q

Where do gliomas arise from.

A

They arise from the glial cells in the brain.

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2
Q

What are gliomas subdivided into. (4)

A

Astrocytomas (most common).
Medulloblastomas.
Ependymomas.
Oligodendrogliomas.

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3
Q

What is the criteria for dividing up gliomas.

A

According to the cell type of origin.

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4
Q

Where do meningiomas arise from.

A

From the arachnoid cells in the meninges.

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5
Q

What is the pathology of meningiomas. (2)

A

They are usually slow growing (over years) and benign.

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6
Q

Where do acoustic neuromas arise from. (2)

A

Schwann cells of cranial nerve 8.

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7
Q

What are acoustic neuromas associated with.

A

Neurofibromatisis.

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8
Q

What are the symptoms of acoustic neuromas. (3)

A

Unilateral deafness.
Facial numbness.
Weakness.

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9
Q

What is the progression of acoustic neuromas. (5)

A

They press on the 5th, 7th, 9th, 10th and 12th cranial nerves as the tumour expands.

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10
Q

What kind of tumours are pituitary tumours.

A

Adenomas.

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11
Q

What may pituitary tumours cause. (2)

A

Endocrine abnormalities (eg hypopituitarism, Cushings’ syndrome).

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12
Q

What is the characteristic sign of a pituitary tumour.

A

Bilateral hemianopia.

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13
Q

What is bilateral hemianopia caused by in the context of a pituitary tumour.

A

The tumour compressing on the optic chiasm.

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14
Q

What is the incidence of lymphoma.

A

It is uncommon.

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15
Q

What group of people are more susceptible to developing lymphoma.

A

AIDS patients.

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16
Q

What cancers can metastasize to the brain. (6)

A 
Breast. 
Lung. 
Stomach. 
Kidney. 
Prostate.
Thyroid.
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17
Q

What percentage of tumours are primary intracranial tumours accountable for.

A

10%

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18
Q

What are the most common type of tumour found in the brain.

A

Metastases. (50%)

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19
Q

What percentage of brain tumours are metastases from other primary tumours.

A

50%

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20
Q

What is the least common type of brain tumour.

A

Benign. (15%)

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21
Q

What are the benign brain tumour types. (2)

A

Meningioma.

Neurofibroma.

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22
Q

What percentage of brain tumours do primary malignant tumours of the neuroepithelial tissue account for.

A

35%

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23
Q

What are the primary malignant tumours of the neuroepithelial tissue. (6)

A 
Astrocytoma. 
Oligodendroglioma. 
Mixed (oligoastrocytomas) gliomas. 
Ependymoma. 
Primary cerebral lymphoma. 
Medulloblastoma.
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24
Q

What is the origin of glioma tumours.

A

Neuroepithelial origin.

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25
Q

Are gliomas malignant or benign.

A

Malignant.

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26
Q

Where are gliomas usually seen in the brain.

A

Usually within the hemispheres.

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27
Q

Where else might gliomas be found. (3)

A

Occasionally in the cerebellum, brainstem or spinal cord.

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28
Q

What is the cause of gliomas.

A

Unknown.

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29
Q

What are gliomas occasionally associated with.

A

Neurofibromatosis.

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30
Q

How do gliomas spread.

A

By direct extension, they virtually never metastasize outside the CNS.

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31
Q

Do gliomas metastasize outside the CNS.

A

Virtually never.

32
Q

What are astrocytomas.

A

Gliomas that arise from astrocytes.

33
Q

How are astrocytomas classified.

A

Histologically into grades 1-4.

34
Q

What is the pathology of grade 1 astrocytomas. (2)

A

Slow growing.

Usually over many years.

35
Q

What is the pathology of grade 4 astrocytomas.

A

They usually cause death within several months.

36
Q

What is another name for a grade 4 astrocytoma.

A

Glioblastoma multiforme.

37
Q

What astrocytoma can occur in childhood.

A

Cystic astrocytomas.

38
Q

What is the pathology of cystic astrocytomas. (2)

A

Benign.

Cerebellar.

39
Q

What are oligodendrogliomas.

A

They are gliomas that arise from oligodendrocytes.

40
Q

What is the pathology of olidogendroliomas. (2)

A

They grow slowly, usually over several decades.

Calcification is normal.

41
Q

What can meningiomas close to the bone do. (2)

A

Erode bone.

Cause local hyperostosis.

42
Q

Where do meningiomas usually occur.

A

Along the intracranial venous sinuses.

43
Q

What are common sites for meningiomas. (5)

A 
Skull base. 
Pituitary fossa. 
Subfrontal region. 
Parasagittal region. 
Sphenoid ridge.
44
Q

Where do neurofibromas usually occur.

A

In the cerebellopontine angle.

45
Q

What kind of tumours are neurofibromas.

A

Benign solid tumours.

46
Q

What is the most common type of pituitary pathology.

A

Pituitary tumours.

47
Q

What are the most common symptoms of pituitary and hypothalamic tumours. What is the cause of these symptoms. (6)

A

Space occupying lesions cause symptoms by exerting pressure on the following structures:
Visual pathways - field defects and visual loss.
Cavernous sinus - CN3,4 and 6.
Bony structures and the meninges surrounding the fossa - headache.
Hypothalamic centres - altered appetite, obesity, thirst, somnolence/wakefulness.
Ventricules - causing interruption of CSF - hypdrcephalus.
Sphenoid sinus with invasion - CSF rhinorrhoea.

48
Q

How do brain tumours cause symptoms. (3)

A

Direct effect - the brain is infiltrated and local function impaired.
Secondary effects of raised ICP and shift of intracranial contents (eg papilloedema, vomiting, headache).
By provoking generalized and/or partial seizures.

49
Q

What is the most common benign brain tumour.

A

Meningioma.

50
Q

Why do primary brain tumours not metastasize.

A

Due to the lack of lymphatic drainage in the brain.

51
Q

What percentage of all tumours do primary brain tumours account for.

A

1%

52
Q

What rare primary brain tumours DOES metastasize.

A

Medulloblastoma. (reason for metastasise is unknown).

53
Q

How are brain tumours graded.

A

WHO grading of 1 to 4.

54
Q

What percentage of primary brain tumours are gliomas.

A

60%

55
Q

What is the most common form of glioma.

A

Glioblastoma multiforme.

56
Q

Where do cerebral lymphomas occur.

A

Cerebral hemisphere.

57
Q

What is the most important prognostic factor for a primary brain tumour.

A

Location (not size).

58
Q

What symptoms are commoner with higher grade cranial tumours. (3)

A

Short 4-6week history of mass effect (headache, nausea secondary to raised ICP).

59
Q

What symptoms are commoner with lower grade cranial tumours. (3)

A

Slowly progressive focal neurological deficits (depending on location).
Generalised or focal seizures are common.
Headaches (if present) are usually accompanied by focal deficits or seizures.

60
Q

How often are isolated headaches due to intracranial tumours.

A

Almost never.

61
Q

What are the characteristics of a headache due to a space occupying lesion. (6)

A

Due to raised ICP.
Headache worse on waking, lying down, bending forward or coughing.
Vomiting.
Papilloedema.

62
Q

What percentage of patients with a space occupying lesion will experience seizures.

A

50%

63
Q

What are some common personality changes seen in patients with space occupying lesions. (4)

A

Irritability.
Lack of application to tasks.
Lack of initiative.
Socially inappropriate behaviour.

64
Q

What are the causes of space occupying lesions in the brain. (6)

A 
Tumours. 
Aneurysm. 
Abscess. 
Chronic subdural haematoma. 
Granuloma. 
Cyst.
65
Q

What are some common symptoms for space occupying lesions in the temporal lobe. (3)

A

Dysphagia.
Contralateral homonymous hemianopia (or upper quadrantanopia if only Meyer’s loop affected).
Amnesia.

66
Q

What are some common symptoms for space occupying lesions in the frontal lobe. (10)

A

Hemiparesis.
Personality changes (eg orbitofrontal syndrome).
Release phenomena such as the grasp reflex.
Broca’s dysphasia.
Unilateral anosmia.
General lack of drive or initiative.
Concrete thinking.
Persevaration (unable to switch from one line of thinking to another).
Executive dysfunctions (eg unable to plan).
Decreased verbal fluency.

67
Q

What are some common symptoms for space occupying lesions in the parietal lobe. (6)

A 
Hemisensory loss. 
Decreased 2 point discrimination. 
Astreognosis (unable to recognise an object by touch alone). 
Sensory inattention. 
Dysphasia. 
Gerstmann's syndrome.
68
Q

What are some common symptoms for space occupying lesions in the occipital lobe. (3)

A

Contralateral visual field defects.
Palinopsia.
Polyopia (seeing multiple images).

69
Q

What are some common symptoms for space occupying lesions in the cerebellum. (7)

A

DASHING.
Dysdiadochokinesis, dysmetria, ataxia, slurred speech (dysarthria), hypotonia, intention tremour, nystagmus, gait abnormality.

70
Q

What are some common symptoms for space occupying lesions in the cerebellopontine angle. (7)

A 
Ipsilateral deafness. 
Nystagmus. 
Decreased corneal reflex. 
Facial weakness (rare). 
Ipsilateral cerebellar signs. 
Papilloedema. 
6th nerve palsy.
71
Q

What are some common symptoms for space occupying lesions in the corpus callosum. (3)

A

Severe rapid intellectual deterioration.
Focal signs of adjacent lobes.
Signes of loss of communication between lobes.

72
Q

What are some common symptoms for space occupying lesions in the midbrain. (2)

A

Failure to up or down gaze.
Light/near dissociated pupil responses with convergence globe retracting nystagmus on attempted up gaze (elicited by looking at a down moving target).

73
Q

What tumours can occur at the cerebellopontine angle. (2)

A

Vestibular schwannoma.

Acoustic neuroma.

74
Q

What is orbitofrontal syndrome. (9)

A

Collection of personality changes:
Lack of empathy, over eating, disinhibition, impulsive behaviour, decreased social skills, over familiarity, unconscious imitation of posture, ‘utilization behaviour’.

75
Q

What is Gerstmann’s syndrome. (4)

A

A collection of symptoms suggesting a dominant parietal lesion.
Finger agnosia (inability to identify fingers).
Agraphia (inability to write).
Acalculia (inability to calculate).
Left-right disorientation.

Cancer, Palliative Care and Pain Medicine (14 decks)

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