CNS tumours Flashcards
What are the signs and syptoms of CNS tumours?
- Headache/vomiting (raised ICP)
- Epilepsy (focal or generalised)
- Focal neurological deficits (dysphagia, hemiparesis, ataxia, visual field defects, hemianopia, agnosia, cognitive impairment)
- Personality change
- Papilloedema/false localising signs (raised ICP)
- Some localising signs (next card)
What investigations would you do for CNS tumours?
CT head - initially
MRI brain - higher sensitivity, DWI and MR spectroscopy can help characterise the lesion without biopsy, f-MRI necessary if the lesion is in dominant hemisphere and is for surgical removal.
CXR/CT TAP - determine if lesion is 2o or 1o
Bloods - CRP, ESR, HIV, toxoplasma
Brain biopsy - type and grading (degree of diff)
LP - BUT C/I IN RAISED ICP as it may cause coning (herniation)
What are 2 features of an olfactory groove tumour?
- Anosmia
- Frontal lobe dysfunction
What are the features of a cavernous sinus tumour? (2)
- Ophthalmoplegia (III, IV, VI nerve palsies)
- V1 and V2 sensory loss
What are the features of a pituitary fossa tumour? (2)
Bitemporal hemianopia (suprasellar expansion and optic chiasm compression)
Hypopituitarism or hypersecretion of specific hormones (e.g. acromegaly, hyperprolactiaemia, Cushing’s disease)
What are 3 complications of CNS tumours?
Pressure effect on surrounding tissue;
- Herniation (falcine, tentorial, tonsillar);
- Cerebrovascular accident (haemorrhage)
- Focal or generalized fits
How common are CNS tumours in children vs adults?
In adults make up 1-2% of all tumours
In children are the most common tumour type making up ~25% of all tumours
What is the histological classification for CNS tumours (based on cell of origin)?
Extra-axial:
- Meningothelial cells – meningioma
- Schwann cells – schwannoma
Intra-axial:
- Astrocytes – astrocytoma
- Oligodendrocytes – oligodendroglioma
- Ependyma – ependymoma
- Neurons – neurocytoma
- Embryonal cells – medulloblastoma (children)
What are the risk factors for CNS tumours?
- Radiation to head and neck
- Neurocarcinogens
- Genetic predisposition e.g. NF
What are the clinical features of CNS tumours which are intracranial, supratentorial and subtentorial?
Intracranial - headache, vomiting, altered GCS
Supratentorial - focal deficits, seizures, personality change
Subtentorial - cerebellar ataxia, long tract signs, CN palsies
What are the management options for CNS tumours?
Surgery
Radiotherapy - used for low and high grade gliomas and metastases
Chemotherapy - used for high grade gliomas (temozolomide), biological agents can also be used
How does WHO classify CNS tumours?
Tumour type (cell of origin) - may predict behaviour
Tumour grade (differentiation)
- Grade I - benign, long survival
- Grade II - low grade, survival >5yrs
- Grade III - high grade, survival <5yrs
- Grade IV - high grade, survival <1yrs
Which is the only types of CNS tumour which is staged?
Medulloblastoma
Name 6 types of glial cells.
- Astrocytes
- Oligodendrocytes
- Ependymal cells
- Schwann cells
- Microglia
- Satellite cells
What is the most common primary type of CNS tumour?
Glial tumour i.e. “Gliomas”
