Intracranial Tumours and other Space-Occupying Lesions Flashcards
What is the most common form of brain tumour?
Metastatic
Which types of cancer most commonly spread to the brain?
Lung (most common)
Breast
Bowel
Skin (namely melanoma)
Kidney
Most common primary tumour in adults?
Glioblastoma multiforme
What does a glioblastoma multiforme look like on imaging?
Solid tumours with central necrosis and a rim that enhances with contrast
Management of glioblastoma multiforme
Surgery with postoperative chemotherapy and/or radiotherapy
Dexamethasone to treat oedema
Second most common primary brain tumour in adults
Meningioma
Where are meningiomas typically located?
Falx cerebri
Superior sagittal sinus
Convexity
Skull base
Management of meningioma
Either observation, radiotherapy or surgical resection
What is a vestibular schwannoma?
(aka acoustic neuroma)
Benign tumour arising from the eighth cranial nerve (vestibulocochlear nerve)
How do vestibular schwannomas present?
Hearing loss
Facial nerve palsy
Tinnitus
Which compartment are most adult brain tumours found?
Supratentorial
Which compartment are most paediatric brain tumours found?
Infratentorial
Management of vestibular schwannoma
Observation, radiotherapy or surgery
What is the most common primary brain tumour in children?
Pilocystic astrocytoma
What type of tumour is associated with von Hippel-Lindau syndrome?
Haemangioblastoma
What is a pituitary adenoma?
Benign tumour of the pituitary gland
They are either secretory or non-secretory
Clinical features of pituitary adenoma
Consequences of hormone excess (e.g. Cushing’s due to ACTH, or acromegaly due to GH) or depletion
Compression of the optic chiasm will cause abitemporal hemianopiadue to the crossing nasal fibres
Investigation in pituitary adenoma
Pituitary blood profile
MRI
Management of pituitary adenoma
Either hormonal or surgical
Clinical features of space-occupying lesions
Headache may be prominent, which is worse on waking, lying down or coughing/straining, and may be associated with vomiting
Early symptoms and signs of raised ICP often non-specific and include headache associated with morning nausea and vomiting
Cranial nerve palsies, in particular the abducens nerve
In advanced cases drowsiness and seizure activity may develop with pupillary abnormalities and papilloedema
Cushing’s reflex may also be demonstrated with raised blood pressure, bradycardia and abnormal breathing (including Cheyne-Stokes respiration)
Investigations in space-occupying lesions
Cranial imaging - MRI more useful for detecting and characterising lesions
Biopsy may be indicated
