Intracranial Tumours Flashcards
Primary intracranial neoplasms are the __ most common tumours in children. True/False?
2nd
List the typical clinical presentations/symptoms of intracranial neoplasms
Progressive neurological deficit
Motor weakness
Headache
Seizures
List clinical presentations/symptoms of raised intracranial pressure
Headache Vomiting Mental changes Seizures Visual impairment
Neurological signs of tumours correlate with anatomical location and function. List the features associated with the frontal lobe and common pathologies
Thought Reasoning Behaviour Memory Movement Broca's aphasia (dominant hemisphere) PERSERVATION (INCREASED SPASTICITY/ TONE)
Neurological signs of tumours correlate with anatomical location and function. List the features associated with the temporal lobe and common pathologies
Behaviour Memory Hearing and vision Emotion Wernicke's aphasia (dominant hemisphere) MEMORY AND AUDITORY HALLUCINATIONS
Neurological signs of tumours correlate with anatomical location and function. List the features associated with the parietal lobe and common pathologies
Intellect Thought Reasoning Memory Sensation INATTENTION/ NEGLECT (non-dominant) GERSTMANN SYNDROME (disease of dominant angular gyrus: dysgraphia, left-right disoreintation, finger agnosia, acalculia)
Neurological signs of tumours correlate with anatomical location and function. List the features associated with the occipital lobe and common pathologies
Speech Motor and sensory Abstract concepts Visual VISUAL FIELD DEFECTS, HAEMANOPIAS
List all potential investigations that may be done for suspected intracranial neoplasms
CT MRI +/- contrast Lumbar puncture PET scan Lesion biopsy EEG Angiography Radionucleotide study
Describe WHO grade I astrocytic tumours
Pilocytic
Pleomorphic xanthoastrocytoma
Describe WHO grade II astrocytic tumours
Low grade astrocytoma
Describe WHO grade III astrocytic tumours
Anaplastic astrocytoma
Describe WHO grade IV astrocytic tumours
Glioblastoma multiforme
Who is typically affected by grade I astrocytic tumours?
Children
Young adults
Typically headache with vomiting and low appetite
What is the treatment of choice for grade I astrocytic tumour?
Surgery (curative)
Grade II astrocytic tumours (low grade astrocytoma) have predilection for which brain lobes?
Temporal
Frontal
Parietal
List poor prognostic factors for low grade astrocytomas
Age over 50 Focal deficit Short duration of symptoms Raised ICP Altered consciousness
Outline treatment options for low grade astrocytomas
Radio/chemo -therapy
Surgery
Which carries poorer prognosis - anaplastic astrocytoma or glioblastoma multiforme?
Glioblastoma multiforme (1 year) Anaplastic astrocytoma (2 years)
List some chemotherapy agents that may be used for astrocytic tumours
Temozolamide (CA inhibitor)
Procarbazine
Carmustine wafers
Which lobe do oligodendroglial tumours predominately affect?
Frontal lobe
Describe the morphology of oligodendroglial tumours (buzzword)
Grayish-pink
Toothpaste-like
Visible calcification!
What is the median survival for oligodendroglial tumours?
10 years
What % of intracranial tumours are meningiomas?
20%
Majority of meningiomas are asymptomatic. True/False?
True
What is meningioma en plaque?
Subtype of meningiomas that infiltrate dura and sometimes bone
Carpet/sheet-like lesions
Meningiomas are usually malignant. True/False?
False Histologically benign (90%)
Outline treatment of meningioma
Pre-operative embolization
Surgery
Radiotherapy
What do pineal tumours typically obstruct?
CSF outflow, leading to hydrocephalus
Raised intracranial pressure can lead to…
Haemorrhage or herniation
What sign would suggest herniation in a patient with raised ICP?
Sudden increase in ICP
What is enclosed within the cranial cavity? Give percentages
80% brain
10% blood
10% CSF
List some features of headache associated with intracranial tumours
Occur in the morning
Typically with coughing/ leaning forward and vomiting
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)
What is Cushing’s triad of ICP?
Hypertension
Bradycardia
Irregular respirations
How do you treat suspected papilloedema in the acute setting?
Mannitol
How do low grade astrocytomas typically present?
Seizures
What sign on imaging would suggest low grade astrocytomas may have grown, and increased grade?
Contrast enhancement
What is the most common primary intracranial tumour?
Glioblastoma multiforme
Outline treatment options for anaplastic astrocytoma and glioblasta multiforme tumours
Noncurative surgery to increase survival
Supramarginal resection
Post-op radiotherapy
Tezolamide
List some side effects of radiotherapy
Reduced IQ
Thin skin
Hair loss
Fatigue
In what situations of intracranial tumours is driving restricted?
Seizure risk
Homonymous visual field defect
FOR 1 YEAR
Who is typically affected by oligodendroglial tumours?
Adults (25-45 years)
Children
How do oligodendroglial tumours typically present?
Seizure
Headaches
Outline treatment options for oligodendroglial tumours
Surgery
CHEMOTHERAPY
(Radiotherapy can reduce seizures and increase life expectancy)
How do meningiomas typically present?
Headaches
Cranial nerve neuropathies (skull base)
Regional anatomical disturbance
What is the median survival for meningiomas?
5 years
What is the most common acoustic neuroma?
Vestibular schwannoma
How do acoustic neuromas typically present?
Loss of hearing
Tinnitus
Dysequilibrium
Hydrocephalus (morning headache)
Outline treatment options for acoustic neuromas
Audiometry Radiographic evaluation VP shunt (hydrocephalus) Radiotherapy Surgery
What are some post-op complications of acoustic neuromas?
Facial nerve palsy
Corneal reflex
Nystagmus
Abnormal eye movement
Who is typically affected by meningiomas?
Females
Who is typically affected by pineal tumours?
Young males (<20 yo)
Germinomas are sensitive to radiotherapy/ chemotherapy
Radiotherapy
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
Which tumour markers are present in germinomas?
bHCG
pALP
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
A raised prolactin or prolactinaemia can be managed with what drug?
Cabergoline
Which harmones are raised in acromegaly? How is it diagnosed and managed?
GH, IGF1
Measure GH levels after glucose
Surgery
Somatostatin analogues
List some signs of cushing’s disease?
Lemon sticks Stria Fatigue Proximal mypopathy Buffalo hump
What is the main complication of acromegaly to be aware of?
Heart failure
What are the main signs of panhypopituitarism? Which harmone declines first?
Pallor, yellow skin, fine wrinkling
Absent axillary hair
Puffy face
Expressionless
GH
GBM tumours are typically found in..
Elderly people
What is the characteristic sign on MRI for GBM tumours?
Butterfly appearance
Haemangioblastomas typically present with what signs?
Signs of raised ICP and cerebellar dysfunction
Haemangioblastomas are associated with what long term condition?
Von-Hippel Linkdau syndrome
What is the characteristic sign on MRI for haemangioblastomas?
Black flow voids in tumour (blood vessels)
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
What anatomical sites are cerebral metastases most likely to be derived from?
Breast
Lung
Skin
Colon
Which intracranial tumour is the most common tumour in children?
Medullablastoma
