CNS Tumours

Question 1

What are some general presentations of brain tumours?

Answer 1

• progressive, focal neurological deficits
• headaches –> worse on lying down, N&V (raised ICP)
• seizures
• gradual cognitive slowing or personality change
• endocrine (pituitary or hypo-thalamic)

Question 2

Name the two high grade gliomas

Answer 2

Anaplastic astrocytomas
Glioblastoma multiforme (GBM)

Question 3

What is the most common type of malignant primary CNS tumour and what are it’s features?

Answer 3

Glioblastoma multiforme

• older people
• MRI –> SOL with necrosis + butterfly appearance

Question 4

What is the treatment for glioblastoma multiforme?

Answer 4

Stupp protocol

–> surgery + radiotherapy +/- radiotherapy (temozolamide)

Question 5

Which types of tumours are more commonly seen in children and young adults?

Answer 5

Low grade gliomas:

• pilocytic astrocytomas (bipolar cells with long finger like projections, cerebellum and midline structures)
• diffuse astrocytomas (frontal and temporal)
• oligodendrogliomas (best prognosis, frontal lobe)

Question 6

What are meningiomas?

Answer 6

Common, benign tumours originating from arachnoidal cap cells

Question 7

What is an acoustic neuroma (vestibular schwannoma) and where would you find it?

Answer 7

Benign tumour of schwann cells

Cerebellopontine angle, on CN8

Question 8

What are the symptoms of vestibular schwannomas?

Answer 8

Unilateral sensorineural hearing loss, tinnitus and vertigo
Headache (rarely) if large
Facial pain/numbness –> trigeminal nerve
Facial nerve can be damaged by treatment

Question 9

What is the management of vestibular schwannomas?

Answer 9

Observe with yearly MRIs

Stereotactic radiosurgery or microsurgical excision if persistently growing

Question 10

What are haemangioblastomas and which syndrome are they commonly associated with?

Answer 10

Benign, cystic, highly vascular tumours

von Hipple-Landau syndrome (multiple haemangiomas, retinal angiomas, renal cell cancer, phaechromocytoma)

Question 11

What are pituitary adenomas?

Answer 11

Benign tumours arising from one of the different cell types in anterior lobe of pituitary gland

• microadenomas < 10mm
• macroadenomas > 10mm

Question 12

How do pituitary adenomas present?

Answer 12

Endocrine dysfunction (due to suppression of hormone secretion or tumour itself releasing hormone)
Bi-temporal hemianopia --> compression of optic chiasm

Question 13

What are the clinical features of a prolactinoma?

Answer 13

Amenorrhoea
Infertility
Galactorrhoea
Loss of libido
Erectile dysfunction

Question 14

How is a prolactinoma diagnosed?

Answer 14

Increased prolactin

Question 15

How do you treat a prolactinoma?

Answer 15

Medical management only –>

Cabergoline (dopamine agonist)

Question 16

How would a growth hormone secreting adenoma present?

Answer 16

Giantism (before puberty)

Acromegaly (after puberty)

Question 17

How would you diagnose a growth hormone secreting adenoma?

Answer 17

Oral glucose tolerance test –>
Measure GH levels after oral glucose loading
- in normal subject, GH will be suppressed
- in acromegaly, GH will increase or stay the same

Question 18

Which disease is caused by an ACTH secreting tumour?

Answer 18

Cushing’s disease

Question 19

How would you define cushing’s syndrome?

Answer 19

Glucocorticoid excess from any cause

Question 20

Describe some features of Cushing’s

Answer 20

Central obesity
Hirsuitism
Abdominal striae
Acne
Hypertension
Glucose intolerance
Muscle wasting + weakness
Osteoporosis
Neuropsychiatric
Immunosuppression
Puffy (moon) face

Question 21

Which test is used to confirm cortisol excess?

Answer 21

Low dose dexamethasone suppression

Question 22

How would you differentiate between an adrenal or pituitary cause of cortisol excess?

Answer 22

High dose dexamethasone suppression test

–> cortisol would be suppressed in pituitary cause only