Intracranial Tumours and other Space-Occupying Lesions

Question 1

What is the most common form of brain tumour?

Answer 1

Metastatic

Question 2

Which types of cancer most commonly spread to the brain?

Answer 2

Lung (most common)

Breast

Bowel

Skin (namely melanoma)

Kidney

Question 3

Most common primary tumour in adults?

Answer 3

Glioblastoma multiforme

Question 4

What does a glioblastoma multiforme look like on imaging?

Answer 4

Solid tumours with central necrosis and a rim that enhances with contrast

Question 5

Management of glioblastoma multiforme

Answer 5

Surgery with postoperative chemotherapy and/or radiotherapy

Dexamethasone to treat oedema

Question 6

Second most common primary brain tumour in adults

Answer 6

Meningioma

Question 7

Where are meningiomas typically located?

Answer 7

Falx cerebri

Superior sagittal sinus

Convexity

Skull base

Question 8

Management of meningioma

Answer 8

Either observation, radiotherapy or surgical resection

Question 9

What is a vestibular schwannoma?

Answer 9

(aka acoustic neuroma)

Benign tumour arising from the eighth cranial nerve (vestibulocochlear nerve)

Question 10

How do vestibular schwannomas present?

Answer 10

Hearing loss

Facial nerve palsy

Tinnitus

Question 11

Which compartment are most adult brain tumours found?

Answer 11

Supratentorial

Question 12

Which compartment are most paediatric brain tumours found?

Answer 12

Infratentorial

Question 13

Management of vestibular schwannoma

Answer 13

Observation, radiotherapy or surgery

Question 14

What is the most common primary brain tumour in children?

Answer 14

Pilocystic astrocytoma

Question 15

What type of tumour is associated with von Hippel-Lindau syndrome?

Answer 15

Haemangioblastoma

Question 16

What is a pituitary adenoma?

Answer 16

Benign tumour of the pituitary gland

They are either secretory or non-secretory

Question 17

Clinical features of pituitary adenoma

Answer 17

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

Question 18

Investigation in pituitary adenoma

Answer 18

Pituitary blood profile

MRI

Question 19

Management of pituitary adenoma

Answer 19

Either hormonal or surgical

Question 20

Clinical features of space-occupying lesions

Answer 20

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)

Question 21

Investigations in space-occupying lesions

Answer 21

Cranial imaging - MRI more useful for detecting and characterising lesions

Biopsy may be indicated