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Y3 NEUROLOGY > Intracranial Tumours > Flashcards

Intracranial Tumours Flashcards

1
Q

Primary intracranial neoplasms are the __ most common tumours in children. True/False?

A

2nd

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2
Q

List the typical clinical presentations/symptoms of intracranial neoplasms

A

Progressive neurological deficit
Motor weakness
Headache
Seizures

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3
Q

List clinical presentations/symptoms of raised intracranial pressure

A 
Headache
Vomiting
Mental changes
Seizures
Visual impairment
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4
Q

Neurological signs of tumours correlate with anatomical location and function. List the features associated with the frontal lobe and common pathologies

A 
Thought
Reasoning
Behaviour
Memory
Movement
Broca's aphasia (dominant hemisphere)
PERSERVATION (INCREASED SPASTICITY/ TONE)
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5
Q

Neurological signs of tumours correlate with anatomical location and function. List the features associated with the temporal lobe and common pathologies

A 
Behaviour
Memory
Hearing and vision
Emotion
Wernicke's aphasia (dominant hemisphere)
MEMORY AND AUDITORY HALLUCINATIONS
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6
Q

Neurological signs of tumours correlate with anatomical location and function. List the features associated with the parietal lobe and common pathologies

A 
Intellect
Thought
Reasoning
Memory
Sensation
INATTENTION/ NEGLECT (non-dominant)
GERSTMANN SYNDROME (disease of dominant angular gyrus: dysgraphia, left-right disoreintation, finger agnosia, acalculia)
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7
Q

Neurological signs of tumours correlate with anatomical location and function. List the features associated with the occipital lobe and common pathologies

A 
Speech
Motor and sensory
Abstract concepts
Visual
VISUAL FIELD DEFECTS, HAEMANOPIAS
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8
Q

List all potential investigations that may be done for suspected intracranial neoplasms

A 
CT
MRI +/- contrast
Lumbar puncture
PET scan
Lesion biopsy
EEG
Angiography
Radionucleotide study
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9
Q

Describe WHO grade I astrocytic tumours

A

Pilocytic

Pleomorphic xanthoastrocytoma

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10
Q

Describe WHO grade II astrocytic tumours

A

Low grade astrocytoma

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11
Q

Describe WHO grade III astrocytic tumours

A

Anaplastic astrocytoma

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12
Q

Describe WHO grade IV astrocytic tumours

A

Glioblastoma multiforme

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13
Q

Who is typically affected by grade I astrocytic tumours?

A

Children
Young adults
Typically headache with vomiting and low appetite

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14
Q

What is the treatment of choice for grade I astrocytic tumour?

A

Surgery (curative)

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15
Q

Grade II astrocytic tumours (low grade astrocytoma) have predilection for which brain lobes?

A

Temporal
Frontal
Parietal

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16
Q

List poor prognostic factors for low grade astrocytomas

A 
Age over 50
Focal deficit
Short duration of symptoms
Raised ICP
Altered consciousness
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17
Q

Outline treatment options for low grade astrocytomas

A

Radio/chemo -therapy

Surgery

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18
Q

Which carries poorer prognosis - anaplastic astrocytoma or glioblastoma multiforme?

A 
Glioblastoma multiforme (1 year)
Anaplastic astrocytoma (2 years)
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19
Q

List some chemotherapy agents that may be used for astrocytic tumours

A

Temozolamide (CA inhibitor)
Procarbazine
Carmustine wafers

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20
Q

Which lobe do oligodendroglial tumours predominately affect?

A

Frontal lobe

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21
Q

Describe the morphology of oligodendroglial tumours (buzzword)

A

Grayish-pink
Toothpaste-like
Visible calcification!

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22
Q

What is the median survival for oligodendroglial tumours?

A

10 years

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23
Q

What % of intracranial tumours are meningiomas?

A

20%

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24
Q

Majority of meningiomas are asymptomatic. True/False?

A

True

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25
What is meningioma en plaque?
Subtype of meningiomas that infiltrate dura and sometimes bone Carpet/sheet-like lesions
26
Meningiomas are usually malignant. True/False?
``` False Histologically benign (90%) ```
27
Outline treatment of meningioma
Pre-operative embolization Surgery Radiotherapy
28
What do pineal tumours typically obstruct?
CSF outflow, leading to hydrocephalus
29
Raised intracranial pressure can lead to...
Haemorrhage or herniation
30
What sign would suggest herniation in a patient with raised ICP?
Sudden increase in ICP
31
What is enclosed within the cranial cavity? Give percentages
80% brain 10% blood 10% CSF
32
List some features of headache associated with intracranial tumours
Occur in the morning | Typically with coughing/ leaning forward and vomiting
33
List the aetiology of tumour headache
Increased tumour headache Compression of dura/ BVs/ periosteum Compression of CNs (III, IV, VI) at the brainstem ---. diplopia Extreme hypertension Psychogenic (stress of loss of functional capacity)
34
What is Cushing's triad of ICP?
Hypertension Bradycardia Irregular respirations
35
How do you treat suspected papilloedema in the acute setting?
Mannitol
36
How do low grade astrocytomas typically present?
Seizures
37
What sign on imaging would suggest low grade astrocytomas may have grown, and increased grade?
Contrast enhancement
38
What is the most common primary intracranial tumour?
Glioblastoma multiforme
39
Outline treatment options for anaplastic astrocytoma and glioblasta multiforme tumours
Noncurative surgery to increase survival Supramarginal resection Post-op radiotherapy Tezolamide
40
List some side effects of radiotherapy
Reduced IQ Thin skin Hair loss Fatigue
41
In what situations of intracranial tumours is driving restricted?
Seizure risk Homonymous visual field defect FOR 1 YEAR
42
Who is typically affected by oligodendroglial tumours?
Adults (25-45 years) | Children
43
How do oligodendroglial tumours typically present?
Seizure | Headaches
44
Outline treatment options for oligodendroglial tumours
Surgery CHEMOTHERAPY (Radiotherapy can reduce seizures and increase life expectancy)
45
How do meningiomas typically present?
Headaches Cranial nerve neuropathies (skull base) Regional anatomical disturbance
46
What is the median survival for meningiomas?
5 years
47
What is the most common acoustic neuroma?
Vestibular schwannoma
48
How do acoustic neuromas typically present?
Loss of hearing Tinnitus Dysequilibrium Hydrocephalus (morning headache)
49
Outline treatment options for acoustic neuromas
``` Audiometry Radiographic evaluation VP shunt (hydrocephalus) Radiotherapy Surgery ```
50
What are some post-op complications of acoustic neuromas?
Facial nerve palsy Corneal reflex Nystagmus Abnormal eye movement
51
Who is typically affected by meningiomas?
Females
52
Who is typically affected by pineal tumours?
Young males (<20 yo)
53
Germinomas are sensitive to radiotherapy/ chemotherapy
Radiotherapy
54
List the types of non-germinomatous tumours, and which tumour markers are useful for each
Teratoma (AFP) Yolk sac tumour (AFP, pALP) Choriocarcioma (bHCG) Embryonal carcinoma
55
Which tumour markers are present in germinomas?
bHCG | pALP
56
Bilateral haemanopia and endocrine abnormality would make you think of which type of tumour? What investigations would you request?
Pituitary tumour Full endocrine profile - prolactin, GH, IGF1, TSH, FT4, FT3, cortisol, FSH/LH MRI Visual fields and acuity
57
A raised prolactin or prolactinaemia can be managed with what drug?
Cabergoline
58
Which harmones are raised in acromegaly? How is it diagnosed and managed?
GH, IGF1 Measure GH levels after glucose Surgery Somatostatin analogues
59
List some signs of cushing's disease?
``` Lemon sticks Stria Fatigue Proximal mypopathy Buffalo hump ```
60
What is the main complication of acromegaly to be aware of?
Heart failure
61
What are the main signs of panhypopituitarism? Which harmone declines first?
Pallor, yellow skin, fine wrinkling Absent axillary hair Puffy face Expressionless GH
62
GBM tumours are typically found in..
Elderly people
63
What is the characteristic sign on MRI for GBM tumours?
Butterfly appearance
64
Haemangioblastomas typically present with what signs?
Signs of raised ICP and cerebellar dysfunction
65
Haemangioblastomas are associated with what long term condition?
Von-Hippel Linkdau syndrome
66
What is the characteristic sign on MRI for haemangioblastomas?
Black flow voids in tumour (blood vessels)
67
What are the main clinical tests used in cushings disease?
Low dose dexa for excess cortisol | High dose dexa to distinguish between adrenal and pituitary causes
68
What anatomical sites are cerebral metastases most likely to be derived from?
Breast Lung Skin Colon
69
Which intracranial tumour is the most common tumour in children?
Medullablastoma

Y3 NEUROLOGY (22 decks)

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