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Neuromuscular management > Lecture 11: Tumors and Infections > Flashcards

Lecture 11: Tumors and Infections Flashcards

1
Q

What is a neoplasm

A

benign or malignant expanding lesion whose constituent cells multiply without restraint and form a mass

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2
Q

What is a primary tumor?

A

arise from CNS cells

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3
Q

What is a secondary tumor?

A

metastatic from other primary sites

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4
Q

Most CNS tumors are __________

A

metastases from other locations n body

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5
Q

What is the most common type of cancer in children?

A

brain/CNS cancer

note: second most common cause of death in children

second most common cause of death in males 20-39

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6
Q

Men have a higher incidence of ____________

women have a higher incidence of ______________

A

men: brain tumors

women: meningeal tumors

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7
Q

What kind of tumor is most common in children?

adults?

A

Children: pilocytic astrocytoma

adults: meningioma and glioblastoma

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8
Q

Where are tumors most commonly found in children?

adults?

A

Children: 70% in posterior fossa

adults: 70% in cerebral hemisphere

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9
Q

What are the two different symptom classifications that tumors cause

A

focal (as a result of the tumor location)

generalized (as a result of overall increased intracranial pressure)

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10
Q

Symptoms of increased intracranial pressure?

A

headache
-worse in am
-worse bending over
-seen in 50% of pts with brain tumor

nausea

papilledema

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11
Q

What does this depict?

A

Hydrocephalus

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12
Q

What does the monroe-kellie doctrine state?

A

There’s only limited volume in the skull, balance of CSF, Blood, and Brain is constant

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13
Q

a subfalcine (cingulate) herniation can compress the __________ artery that runs along the falx, can cause infarction and further swelling

A

ACA

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14
Q

A cingulate herniation presses the ___________ under the falx to the contralateral side

A

cerebral hemisphere

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14
Q

What symptoms does pressure on the tentorial notch from an uncal herniation cause

A

Ipsilateral dilated pupil (CN III)

impaired conciousness

hemiparesis

PCA infarcts

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14
Q

uncal herniation affects what parts of the brain?

A

hippocampus, uncus of temporal lobe, tentorial notch

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15
Q

What kind of herniation pushes the brain through the foramen magnum?

A

Tonsillar herniation : pushes the cerebellar tonsils through the foramen magnum

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16
Q

What is compressed due to a tonsillar hernation?

A

4th ventrical and medulla

symptoms: stiff neck progressing to decerebrate posturing and coma

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17
Q

What kind of imaging is best for CNS tumors?

A

MRI

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18
Q

What is a tumor in the spinal cord called?

A

intramedullary

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19
Q

What is a tumor lying on the surface of the cord that arises from roots or meninges called?

A

extramedullary-intradural

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20
Q

what is a tumor in the epidural space that is able to compress the spinal cord called?

A

extradural

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21
Q

What kind of spinal cord tumor is most commonly from metastases?

A

extradural

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22
Q

How are CNS tumors named?

A

based on their hisological appearance to CNS cell types

example:

gliomas- glial cells

mengiomas - arachnoid cels

neuroblastoma, neurocytoma- neurons

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23
Q

What is the most common tumor location?

A

Meninges/meningioma

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24
Q

What kind of brain tumor has the worst prognosis?

A

glioblastoma

-very high rate of mitosis, vascular proliferation, necrosis

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25
Q

Grade 1 glioma?

A

Pilocytic Astrocytoma

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26
Q

grade 2 glioma?

A

low grade astrocytoma

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27
Q

grade 3 glioma?

A

anaplastic astrocytoma

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28
Q

grade 4 glioma?

A

glioblastoma

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29
Q

What is the most common location of astrocytoma?

A

Cerebral hemisphere

mostly supra-tentorial

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30
Q

Astrocytoma prognosis?

A

median survival 9-17 years
80% survive 5+ years

continous monitoring from malignant transformation

treatment: surgery, radiation, chemo

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31
Q

What factors would indicate a favorable prognosis for astrocytoma?

A

Younger age

seizure as only symptom (not headache)

smaller tumor size

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32
Q

Glioblastoma has a higher incidence in ___________

median survival?

presenting symptoms?

A

men

1.5 years

focal signs, cognitive changes, increasing ICP

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33
Q

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

A

Medullablastoma

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34
Q

What kind of brain tumor can block the 4th ventrical and cause hydrocephalus?

A

medulloblastoma

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35
Q

What is the most common primary brain tumor?

A

Meningioma

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36
Q

What kind of tumor is benign, slow growing, incidence increases w/ age, and affects more females than males

A

meningioma

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37
Q

What is the most common form of brain cancer in adults?

A

metastasis from other cancers

-primarily from lungs (50%)
-breasts (15%)

38
Q

What does this MRI show?

A

Metastases to CNS

(usually multiple masses at gray/white junction)

39
Q

T or F, metastases is usually found in routine workup

A

T

40
Q

What drug treats raised intracranial pressure?

What drug treats seizures?

A

Dexamethasone, Mannitol

Levetiracatem or Lacosamide

41
Q

Most spinal cord metastases occur where?

A

70% Thoracic

42
Q

What are the symptoms of spinal cord metastases?

A

Back pain, tenderness, paraparesis, incontinence

43
Q

Ambulatory vs nonambulatory prognosis for spinal metastatic disease?

A

If ambulatory, 90% of patients remain ambulatory

if nonambulatory under 10% of patients survive 1 year

44
Q

Where is leptomeningeal metastases?

Prognosis?

A

Either at the basal cistern or cauda equina, 5% of all metastatic cancers

usually very poor prognosis

45
Q

What is paraneoplastic disease

A

group of disorders that are associated with cancer but not directly caused by cancer

46
Q

Polyneuropathy

Polymyositis or dematomyositis

cerebellar degen

limbic or brainstem encephalitis

necrotizing myelopathy

lambert eaton

These are all what?

A

Paraneoplastic disorders

47
Q

Chemotherapy complications

A

Neuropathy

delirium

dementia

seizures

headache

vision loss

cerebellar dysfunction

48
Q

radiation complications

A

headache

worsening of neurological symptoms

radiation necrosis

cognitive impairment

neuropathy

myelopathy

vasculopathy

endocrinopathy

49
Q

meningitis, brain abscess, subdural empyema, dural sinus thrombophlebitis, and focal bacterial encephalitis

these are are examples of…

A

bacterial infections of the CNS

50
Q

What are the symptoms of meningitis?

A

Fever Chills

Headache

neckpain/stiffness

generalized convulsions

drowsiness/confusion

51
Q

What is one major symptom of meningitis in infants

A

Buldging of fontanels (soft spots)

note: also vomiting/irritability

52
Q

What is brudzinski’s neck sign?

Kernig’s sign?

A

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

53
Q

Meningitis causes thrombosis in _______ more than ________

A

veins more than arteries

54
Q

How does meningitis cause hydrocephalus?

A

Bacteria in CSF causes inflammatory reaction -> exudate of neutrophils and proteins -> exudate blocks uptake of CSF causing hydrocephalus

55
Q

CSF in meningitis will show

____ WBC

____ Protein

____ glucose

A

increased

increased

decreased

note: cloudy appearance

56
Q

What common pathogens can give newborns meningitis?

A

E Coli

57
Q

T or F, acute menngitis is a medical emergency

A

T

58
Q

T or F, Bacterial meningitis often requires a higher dose of antibiotics to penetrate the blood brain barrier

A

T

59
Q

What kind of meningitis tends to occur in roughly 10 year cycles

has a rapid onset over hours

and leads to hemorrhagic skin rash

A

Meningococcal meningitis

60
Q

What is the difference between viral meningitis and bacterial meningitis?

A

Viral Meningitis

  • CSF has lymphocytic predominance (not WBCs)
  • Normal glucose levels

Bacterial Meningitis

  • Increase WBC
  • Increase protien
  • Decrease glucose
61
Q

What are the 2 most common viral causes of meningitis?

A

enterovirus, herpes simplex virus

62
Q

What is acyclovir medicine

A

Used to treat herpes simplex virus

63
Q

What kind of meningitis should be assumed for treatment purposes before tests are ran?

A

Bacterial

64
Q

What is the hallmark of acute encephalitis

A

Impaired conciousness

note: also fever, impaired conciousness, seizures, hemiparesis, ataxia, cranial nerve palsies

65
Q

Herpes simplex encephalitis is usually caused by what kind of HSV?

A

HSV1

66
Q

What is the worst kind of viral encephalitis

what lobes does it affect

A

herpes simplex

mortality rate of 50%

usually dominates in temporal and frontal lobes

67
Q

How does herpes simplex encephalitis present and evolve?

A

rapid evolution of fever, confusion, coma

68
Q

Whats the difference in progression between HSV1 meningitis and tuberculosis meningitis

A

HSV1 progresses rapidly

tuberculosis progresses over weeks

69
Q

how does tuberculosis reach the brain?

A

from bloodstream after pulmonary infection

note: hydrocephalus and stroke are frequent w/ tuberculosis meningitis

70
Q

What symptoms are frequent w/ tuberculous meningitis

A

cranial nerve palsies

71
Q

What does the CSF look like (lab values) during tuberculosis meningitis?

A

increased pressure

increased lymphocytes

increased protein

and decreased glucose

72
Q

What condition is this?

Purulent infection of the subdural space

A

Subdural empyema

73
Q

where does subdural empyema usually come from?

A

Arises from sinus or middle ear

74
Q

How is subdural empyema usually treated

A

surgical drainage and then antibiotic afterwards

75
Q

What is intracranial thrombophlebitis

A

thrombosis in venous sinus caused by infection

blockage leads to increase ICP and focal neurological finding

76
Q

What is a brain abscess?

A

occurs when there is necrosis of brain tissue along with bacterial infection

77
Q

Where will a brain abscess usually appear that is secondary to ear or sinus infection

A

near the site of entry

78
Q

what are the symptoms of brain abscess?

A

headache

drowsiness

confusion

seizures

focal findings

79
Q
A
80
Q

What are the 3 stages of neurosyphilis

A
  1. early meningitis - 6-12 months after infection
  2. meningovascular syphilis - 5-12 years after primary infecton
  3. late tertiary syphilis - tabes dorsalis and general paresis
81
Q

Where does lyme disease come from?

A

Transmitted by bite of infected blacklegged tick
(not in texas)

borrelia burgdorferi bacteria

82
Q

What are the symptoms of lyme disease

initially:

weeks- months:

A

initially: fever, rash, fatigue, headache

weeks- months: CN palsies, meningitis, radiculopathy, neuropathy, cardiac disease

83
Q

What 2 fungi can infect the CNS?

A

Cryptococcosis - most common in US, seen in AIDS patients

Mucormyocosis - seen as complication of diabetes

84
Q

What kind of pattern does a rash from herpes zoster/shingles cause?

A

appears as a dermatomal pattern of just one dermatome

85
Q

Where does herpes zoster/shingles infection come from? Who does it affect? What does it cause?

A

reactivation of latent chicken pox virus

usually affects elderly

causes radicular pain

86
Q

What is the most common neurological symptoms of covid?

A

Anosmia (75%)

note: other CNS complications seen in 30% of patients

87
Q

What are the most common symptoms of long covid?

A

Dyspnea, Fatigue

88
Q

What is prion disease?
Symptoms?
Prognosis?

A

Sporadic creutzfeldt-jakob disease

(caused by prion proteins)

causes rapidly progressive dementia, behavior changes, ataxia, myoclonic jerks, blindness

fatal within 1 year

89
Q

Most mass lesions of the brain in AIDS are ____________

A

toxoplasmosis or primary CNS lymphoma

90
Q

With HIV and AIDS, opportunitistic infection is seen when the __________ count drops

A

CD4

91
Q

T or F, AIDS and HIV can affect the nervous system at any level

A

T

92
Q

What is neurocytiscerosis?

A

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

93
Q

What are the symptoms of neurocysticerosis?

A

seizure, headache, arachnoiditis (inflammatory reaction to cysts in arachnoid space)

94
Q

How do you treat neurocysticerosis?

A

Antiparasitics (still need surgery after to remove the dead worms bc they still cause seizures)

steroids

surgery

Neuromuscular management (19 decks)

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