HNNS Case 4: Meningioma Flashcards

1
Q

List of DDx for progressive visual loss in adults

A
  1. Cataract
  2. Glaucoma
  3. Age-related macular degeneration
  4. Diabetic retinopathy
  5. Cerebrovascular disease
  6. Visual cortex disorder
  7. Retinal problem —> Floater / Photopsia

Investigations:

  1. Injury
  2. Headache / vomiting
  3. Neurological deficits
  4. CN palsies —> Pupillary light reflex
  5. Visual acuity —> Turbidity of lens, Yellow spot, Peripheral retina
  6. DM
  7. Hypertension
  8. Infection / Inflammation
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2
Q

Anatomy of eye and visual pathway in clinical context

A

See lecture

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3
Q

Different pathologies that occur at the suprasellar region

A

Sella turcica tumour

  1. Pituitary adenoma
    - Prolactinoma
    - ACTH-producing tumour
    - Non-functional adenoma
  2. Craniopharyngioma

Intracranial tumour

  1. Astrocytoma
  2. Glioblastoma
  3. Meningioma
  4. Metastatic tumour
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4
Q

Investigations for Sella turcica tumour

A
  1. Blood tests for hormones

2. CT / MRI

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5
Q

Dexamethasone use

A
  1. Control cerebral edema due to hydrocephalus

2. Meningioma associated with lower level of glucocorticoid receptor

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6
Q

Common types and prognosis of benign intracranial tumours

A
  1. Histology grade
  2. Nature of tumour site (operable?)
  3. 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
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7
Q

Midline structures in neuroimaging

A

See notes

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8
Q

Potential early and delayed complications in surgical treatment of suprasellar lesions

A

Complications:
1. Infection, haemorrhage, blood clot, inflammation

  1. Disturbance for somatosensation
  2. Leakage of CSF
    - tear of meninges during surgery
    - abnormal accumulation of CSF after surgery due to inflammation —> hydrocephalus —> ↑ ICP —> CSF leak
    - monitor ***nasal discharge
  3. 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
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9
Q

Support for visually impaired in HK

A
  1. Social Welfare Department
    - Vocational rehabilitation services
    - Residential services
    - Community support services
  2. Hong Kong Blind Union
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10
Q

Importance of vigilant follow up and consideration of alternative diagnosis when symptoms failed to improve

A

Importance of vigilant follow up and consideration of alternative diagnosis when symptoms failed to improve

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11
Q

Visual acuity

A

Highest: 1

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12
Q

Pale optic disc

A
  • Location of exit of Optic nerve (i.e. Blind spot)
  • Sign of death of optic nerve
  • Appear weeks / months after axons have died
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