Lecture 11: Tumors and Infections Flashcards
What is a neoplasm
benign or malignant expanding lesion whose constituent cells multiply without restraint and form a mass
What is a primary tumor?
arise from CNS cells
What is a secondary tumor?
metastatic from other primary sites
Most CNS tumors are __________
metastases from other locations n body
What is the most common type of cancer in children?
brain/CNS cancer
note: second most common cause of death in children
second most common cause of death in males 20-39
Men have a higher incidence of ____________
women have a higher incidence of ______________
men: brain tumors
women: meningeal tumors
What kind of tumor is most common in children?
adults?
Children: pilocytic astrocytoma
adults: meningioma and glioblastoma
Where are tumors most commonly found in children?
adults?
Children: 70% in posterior fossa
adults: 70% in cerebral hemisphere
What are the two different symptom classifications that tumors cause
focal (as a result of the tumor location)
generalized (as a result of overall increased intracranial pressure)
Symptoms of increased intracranial pressure?
headache
-worse in am
-worse bending over
-seen in 50% of pts with brain tumor
nausea
papilledema
What does this depict?
Hydrocephalus
What does the monroe-kellie doctrine state?
There’s only limited volume in the skull, balance of CSF, Blood, and Brain is constant
a subfalcine (cingulate) herniation can compress the __________ artery that runs along the falx, can cause infarction and further swelling
ACA
A cingulate herniation presses the ___________ under the falx to the contralateral side
cerebral hemisphere
What symptoms does pressure on the tentorial notch from an uncal herniation cause
Ipsilateral dilated pupil (CN III)
impaired conciousness
hemiparesis
PCA infarcts
uncal herniation affects what parts of the brain?
hippocampus, uncus of temporal lobe, tentorial notch
What kind of herniation pushes the brain through the foramen magnum?
Tonsillar herniation : pushes the cerebellar tonsils through the foramen magnum
What is compressed due to a tonsillar hernation?
4th ventrical and medulla
symptoms: stiff neck progressing to decerebrate posturing and coma
What kind of imaging is best for CNS tumors?
MRI
What is a tumor in the spinal cord called?
intramedullary
What is a tumor lying on the surface of the cord that arises from roots or meninges called?
extramedullary-intradural
what is a tumor in the epidural space that is able to compress the spinal cord called?
extradural
What kind of spinal cord tumor is most commonly from metastases?
extradural
How are CNS tumors named?
based on their hisological appearance to CNS cell types
example:
gliomas- glial cells
mengiomas - arachnoid cels
neuroblastoma, neurocytoma- neurons
What is the most common tumor location?
Meninges/meningioma
What kind of brain tumor has the worst prognosis?
glioblastoma
-very high rate of mitosis, vascular proliferation, necrosis
Grade 1 glioma?
Pilocytic Astrocytoma
grade 2 glioma?
low grade astrocytoma
grade 3 glioma?
anaplastic astrocytoma
grade 4 glioma?
glioblastoma
What is the most common location of astrocytoma?
Cerebral hemisphere
mostly supra-tentorial
Astrocytoma prognosis?
median survival 9-17 years
80% survive 5+ years
continous monitoring from malignant transformation
treatment: surgery, radiation, chemo
What factors would indicate a favorable prognosis for astrocytoma?
Younger age
seizure as only symptom (not headache)
smaller tumor size
Glioblastoma has a higher incidence in ___________
median survival?
presenting symptoms?
men
1.5 years
focal signs, cognitive changes, increasing ICP
What kind of brain tumor is located in the cerebellum, primary affects children at the age of 6, and drops metastases into the CNS/spinal cord
Medullablastoma
What kind of brain tumor can block the 4th ventrical and cause hydrocephalus?
medulloblastoma
What is the most common primary brain tumor?
Meningioma
What kind of tumor is benign, slow growing, incidence increases w/ age, and affects more females than males
meningioma
What is the most common form of brain cancer in adults?
metastasis from other cancers
-primarily from lungs (50%)
-breasts (15%)
What does this MRI show?
Metastases to CNS
(usually multiple masses at gray/white junction)
T or F, metastases is usually found in routine workup
T
What drug treats raised intracranial pressure?
What drug treats seizures?
Dexamethasone, Mannitol
Levetiracatem or Lacosamide
Most spinal cord metastases occur where?
70% Thoracic
What are the symptoms of spinal cord metastases?
Back pain, tenderness, paraparesis, incontinence
Ambulatory vs nonambulatory prognosis for spinal metastatic disease?
If ambulatory, 90% of patients remain ambulatory
if nonambulatory under 10% of patients survive 1 year
Where is leptomeningeal metastases?
Prognosis?
Either at the basal cistern or cauda equina, 5% of all metastatic cancers
usually very poor prognosis
What is paraneoplastic disease
group of disorders that are associated with cancer but not directly caused by cancer
Polyneuropathy
Polymyositis or dematomyositis
cerebellar degen
limbic or brainstem encephalitis
necrotizing myelopathy
lambert eaton
These are all what?
Paraneoplastic disorders
Chemotherapy complications
Neuropathy
delirium
dementia
seizures
headache
vision loss
cerebellar dysfunction
radiation complications
headache
worsening of neurological symptoms
radiation necrosis
cognitive impairment
neuropathy
myelopathy
vasculopathy
endocrinopathy
meningitis, brain abscess, subdural empyema, dural sinus thrombophlebitis, and focal bacterial encephalitis
these are are examples of…
bacterial infections of the CNS
What are the symptoms of meningitis?
Fever Chills
Headache
neckpain/stiffness
generalized convulsions
drowsiness/confusion
What is one major symptom of meningitis in infants
Buldging of fontanels (soft spots)
note: also vomiting/irritability
What is brudzinski’s neck sign?
Kernig’s sign?
signs of meningitis
brudzinski- flexing patient’s neck caused flexion of hips and knees
kernigs sign- flexing patients hip to 90 then extending patients knee causes pain
Meningitis causes thrombosis in _______ more than ________
veins more than arteries
How does meningitis cause hydrocephalus?
Bacteria in CSF causes inflammatory reaction -> exudate of neutrophils and proteins -> exudate blocks uptake of CSF causing hydrocephalus
CSF in meningitis will show
____ WBC
____ Protein
____ glucose
increased
increased
decreased
note: cloudy appearance
What common pathogens can give newborns meningitis?
E Coli
T or F, acute menngitis is a medical emergency
T
T or F, Bacterial meningitis often requires a higher dose of antibiotics to penetrate the blood brain barrier
T
What kind of meningitis tends to occur in roughly 10 year cycles
has a rapid onset over hours
and leads to hemorrhagic skin rash
Meningococcal meningitis
What is the difference between viral meningitis and bacterial meningitis?
Viral Meningitis
- CSF has lymphocytic predominance (not WBCs)
- Normal glucose levels
Bacterial Meningitis
- Increase WBC
- Increase protien
- Decrease glucose
What are the 2 most common viral causes of meningitis?
enterovirus, herpes simplex virus
What is acyclovir medicine
Used to treat herpes simplex virus
What kind of meningitis should be assumed for treatment purposes before tests are ran?
Bacterial
What is the hallmark of acute encephalitis
Impaired conciousness
note: also fever, impaired conciousness, seizures, hemiparesis, ataxia, cranial nerve palsies
Herpes simplex encephalitis is usually caused by what kind of HSV?
HSV1
What is the worst kind of viral encephalitis
what lobes does it affect
herpes simplex
mortality rate of 50%
usually dominates in temporal and frontal lobes
How does herpes simplex encephalitis present and evolve?
rapid evolution of fever, confusion, coma
Whats the difference in progression between HSV1 meningitis and tuberculosis meningitis
HSV1 progresses rapidly
tuberculosis progresses over weeks
how does tuberculosis reach the brain?
from bloodstream after pulmonary infection
note: hydrocephalus and stroke are frequent w/ tuberculosis meningitis
What symptoms are frequent w/ tuberculous meningitis
cranial nerve palsies
What does the CSF look like (lab values) during tuberculosis meningitis?
increased pressure
increased lymphocytes
increased protein
and decreased glucose
What condition is this?
Purulent infection of the subdural space
Subdural empyema
where does subdural empyema usually come from?
Arises from sinus or middle ear
How is subdural empyema usually treated
surgical drainage and then antibiotic afterwards
What is intracranial thrombophlebitis
thrombosis in venous sinus caused by infection
blockage leads to increase ICP and focal neurological finding
What is a brain abscess?
occurs when there is necrosis of brain tissue along with bacterial infection
Where will a brain abscess usually appear that is secondary to ear or sinus infection
near the site of entry
what are the symptoms of brain abscess?
headache
drowsiness
confusion
seizures
focal findings
What are the 3 stages of neurosyphilis
- early meningitis - 6-12 months after infection
- meningovascular syphilis - 5-12 years after primary infecton
- late tertiary syphilis - tabes dorsalis and general paresis
Where does lyme disease come from?
Transmitted by bite of infected blacklegged tick
(not in texas)
borrelia burgdorferi bacteria
What are the symptoms of lyme disease
initially:
weeks- months:
initially: fever, rash, fatigue, headache
weeks- months: CN palsies, meningitis, radiculopathy, neuropathy, cardiac disease
What 2 fungi can infect the CNS?
Cryptococcosis - most common in US, seen in AIDS patients
Mucormyocosis - seen as complication of diabetes
What kind of pattern does a rash from herpes zoster/shingles cause?
appears as a dermatomal pattern of just one dermatome
Where does herpes zoster/shingles infection come from? Who does it affect? What does it cause?
reactivation of latent chicken pox virus
usually affects elderly
causes radicular pain
What is the most common neurological symptoms of covid?
Anosmia (75%)
note: other CNS complications seen in 30% of patients
What are the most common symptoms of long covid?
Dyspnea, Fatigue
What is prion disease?
Symptoms?
Prognosis?
Sporadic creutzfeldt-jakob disease
(caused by prion proteins)
causes rapidly progressive dementia, behavior changes, ataxia, myoclonic jerks, blindness
fatal within 1 year
Most mass lesions of the brain in AIDS are ____________
toxoplasmosis or primary CNS lymphoma
With HIV and AIDS, opportunitistic infection is seen when the __________ count drops
CD4
T or F, AIDS and HIV can affect the nervous system at any level
T
What is neurocytiscerosis?
worms in the brain
worms in the brain
worms in the brain
worms in the brain
worms in the brain
worms in the brain
worms in the brain
worms in the brain
worms in the brain
worms in the brain
worms in the brain
worms in the brain
worms in the brain
worms in the brain
worms in the brain
What are the symptoms of neurocysticerosis?
seizure, headache, arachnoiditis (inflammatory reaction to cysts in arachnoid space)
How do you treat neurocysticerosis?
Antiparasitics (still need surgery after to remove the dead worms bc they still cause seizures)
steroids
surgery
