HNNS Case 4: Meningioma Flashcards
List of DDx for progressive visual loss in adults
- Cataract
- Glaucoma
- Age-related macular degeneration
- Diabetic retinopathy
- Cerebrovascular disease
- Visual cortex disorder
- Retinal problem —> Floater / Photopsia
Investigations:
- Injury
- Headache / vomiting
- Neurological deficits
- CN palsies —> Pupillary light reflex
- Visual acuity —> Turbidity of lens, Yellow spot, Peripheral retina
- DM
- Hypertension
- Infection / Inflammation
Anatomy of eye and visual pathway in clinical context
See lecture
Different pathologies that occur at the suprasellar region
Sella turcica tumour
- Pituitary adenoma
- Prolactinoma
- ACTH-producing tumour
- Non-functional adenoma - Craniopharyngioma
Intracranial tumour
- Astrocytoma
- Glioblastoma
- Meningioma
- Metastatic tumour
Investigations for Sella turcica tumour
- Blood tests for hormones
2. CT / MRI
Dexamethasone use
- Control cerebral edema due to hydrocephalus
2. Meningioma associated with lower level of glucocorticoid receptor
Common types and prognosis of benign intracranial tumours
- Histology grade
- Nature of tumour site (operable?)
- Response to chemotherapy (Rapid-growing tumour more responsive)
Benign:
- Meningioma
- Schwannoma
- Pituitary adenoma
- Craniopharyngioma
Very malignant:
- Glioblastoma
- Medulloblastoma
Good prognosis:
- Oligodendroglioma
- Medulloblastoma
- Meningioma
- Schwannoma
Poor prognosis:
- Astrocytoma
- Glioblastoma
- Ependymoma
Midline structures in neuroimaging
See notes
Potential early and delayed complications in surgical treatment of suprasellar lesions
Complications:
1. Infection, haemorrhage, blood clot, inflammation
- Disturbance for somatosensation
- Leakage of CSF
- tear of meninges during surgery
- abnormal accumulation of CSF after surgery due to inflammation —> hydrocephalus —> ↑ ICP —> CSF leak
- monitor ***nasal discharge - Damage to pituitary gland
- affect hormone
—> **ADH / ACTH to make aldosterone
—> Hyper / Hyponatraemia
—> Disorder of water balance
—> can be fatal
—> monitor **Fluid intake + ***Urine output
Support for visually impaired in HK
- Social Welfare Department
- Vocational rehabilitation services
- Residential services
- Community support services - Hong Kong Blind Union
Importance of vigilant follow up and consideration of alternative diagnosis when symptoms failed to improve
Importance of vigilant follow up and consideration of alternative diagnosis when symptoms failed to improve
Visual acuity
Highest: 1
Pale optic disc
- Location of exit of Optic nerve (i.e. Blind spot)
- Sign of death of optic nerve
- Appear weeks / months after axons have died
