CNS Tumours Clinical Flashcards
What is the aetiolgoy of brain tumours?
Primary unknown
Genetic
Metastatic causes
What are the most common primary sites of brain metastases?
Lung Kidney Breast GI Melanoma
How are CNS tumours classified?
Based on tissue of origin
Location
Primary or secondary
Grading
How are tumours graded?
GX Grade cannot be assessed (Undetermined)
G1 Well-differentiated (Low grade)
G2 Moderately differentiated (Intermediate grade)
G3 Poorly differentiated (High grade)
G4 Undifferentiated (High grade)
How do CNS tumours present?
Depends on location, size and type of tumour
What are the general signs and symptoms of CNS tumours?
Increased ICP Causing: Headaches worse in morning Nausea Vomiting Papilleedema Cognitive impairment Altered consciousness Focal neurologic deficits Seizures
What are the signs and symptoms of cerebral tumours?
Headache Vomiting Hemiparesis Hemiplegia Hypokinesia Seizures Changes in personality or behaviour
What are the signs and symptoms of brainstem tumours?
o Hearing loss (acoustic neuroma) o Facial pain and weakness o Dysphagia, decreased gag reflex o Nystagmus o Hoarseness o Ataxia
What is the sign in cerebellar tumours?
Disturbances in co-ordination and equilibrium
What are the signs and symptoms of a pituitary tumour?
Endocrine dysfunction Visual deficits (pressure on the optic chiasma) Headache
What are the signs and symptoms of a frontal lobe tumour?
Inappropriate behavior Personality changes Inability to concentrate Impaired judgment Memory loss Headache Expressive aphasia Motor dysfunctions
What are the signs and symptoms of a parietal lobe tumour?
Sensory deficits
Paresthesia
Loss of 2 pt discrimination
What is the sign of a occipital lobe tumour?
Visual disturbances
What are the classifications of intra-axial tumours?
- Gliomas
1. Astrocytoma (Grades
I,II)
2. Anaplastic
Astrocytoma(III)
3. Glioblastoma
Multiforme(IV) - Oligodendroglioma
- Ependymomas
- Medulloblastoma
- CNS Lymphoma
What are the classifications of an extra-axial tumour?
Meningioma Metastatic Acoustic neuromas Pituitary adenoma Neurofibroma
What are the characteristics of meningiomas?
Slow growing
Attached to meninges
Usually benign
What is the 2nd most common primary brain tumour?
Meningioma
Where do meningiomas arise from?
Arachnoid cap cells from arachnoid membrane
Are meningiomas invasive?
Not usually
Do meningiomas affect more F or M?
F
What are the symptoms of meningioma?
Generally slow growing so asymptomatic for ages Headaches Blurred vision Numbness Speech problems Seizures
What imaging is done for meningioma?
CT
MRI
What other investigation can be done for meningioma?
Biopsy
What is the scale for astrocytomas?
- Low grade astrocytomas
- Diffuse low grade astrocytomas
- Glioblastomas
What is the presentation of diffuse low grade astrocytoma?
Seizures
Headache
Slowly progressive neurological deficits
Which is the most common primary type of brain tumour in adults?
High grade glioblastoma
Where are high grade glioblastomas usually located?
Cerebral hemispheres
Where are diffuse grade astrocytomas usually located?
Frontal region
How do high grade glioblastomas present?
Seizures
Headache
Slowly progressive neurological deficits
Where do oligodendrogliomas arise from?
Myelin
Where are oligodendrogliomas located?
Superficially in frontal lobes
What is the presentation of oligodendrogliomas?
Seizures
Headache
Slowly progressive neurological deficits
What are investigations for oligodendrogliomas?
CT
MRI
Are brain mets single or multiple?
Can be either
What investigations should be used to diagnose CNS tumours?
CT
MRI
PET scan
Which investigation is most widely used for the diagnosis for brain tumours?
CT
What is CT more useful for than MRI?
Detecting acute haemorrhage, calcification and bony involvement
What are the benefits of MRI scanning for brain tumours?
More sensitive than CT scan
Can detect small tumours
Provides much greater anatomical detail
Good for visualising tumours of the skull base, brain stem and posterior fossa tumours
What is the surgical treatment for CNS tumours?
Resection
Biopsy
When might you use a transsphenoidal route?
Approach through nasal pasage to remove pituitary tumour
What does radiation therapy?
Damages DNA of rapidly dividing cells
What does chemotherapy do?
Slows cell growth
What is the purpose of performing a biopsy?
To remove a piece of the tissue to determine the type of tumour
What are the risk factors for CNS tumours?
Often unknown
FH
Ionizing radiation
Environmental hazards
What investigation is contraindicated in CNS tumours?
LP
What is the treatment for glioblastoma?
Complete excision impossible Biopsy or debulk Radiotherapy Corticosteroids Anticonvulsants
What is the most common pituitary tumour?
Pituitary adenoma
What would bitemporal hemianopia suggest?
Pituitary tumour
What are red flags for CNS tumours?
Weight loss Anorexia Focal neurological deficit Change in headache Worse in morning headache Signs of increased ICP Vomiting Seizures
What is the treatment for pituitary adenoma?
Endocrine replacement
Transsphenoidal surgery
Drug therapy
Radiotherapy
