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Neurology > Lecture 37 Brain Tumours (Clinical) > Flashcards

Lecture 37 Brain Tumours (Clinical) Flashcards

1
Q

Name primary tumours

A

Glioma
Meningioma
Pituitary

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2
Q

What are the commonest tumours that spread to the brain

A
  • Renal cell carcinoma
  • Lung carcinoma
  • Breast carcinoma
  • Malignant melanoma
  • GI tract
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3
Q

Where are gliomas derived from

A

Astrocytes- structural and nutritional support of nerve cells

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4
Q

Describe Gliomas

A 
•	WHO grade I-IV
o	Most common 
o	Most aggressive
o	Glioblastoma multiforme (GBM)
o	Spread by tracking through white mater and CSF pathway
o	Very rarely spread systemically
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5
Q

Describe Meningiomas

A 
o	Slow growing
o	Extra-axial
o	Usually benign
o	Arise from arachnoid
o	Frequently occur along falx, convexity or sphenoid bone
o	Usually cure if completely removed
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6
Q

Describe Pituitary tumours

A 
•	Adenoma most common
•	Only 1% tumours malignant
•	Presentation
–	visual disturbance
•	compression of optic chiasm
–	hormone imbalance
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7
Q

Clinical presentation of brain tumours

A
  • Raised ICP
  • Focal neurological deficit
  • Epileptic fits
  • CSF obstruction
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8
Q

Raised ICP symptoms

A
  • Headache- morning due to reduced venous return leading to venous congestion
  • Nausea/vomiting- hyperventilation
  • Visual disturbance (diplopia, blurred vision)
  • Somnolence
  • Cognitive impairment
  • Altered consciousness
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9
Q

Raised ICP signs

A
  • Papilloedema
  • 6th nerve palsy- Abducens- longest course
  • Cognitive impairment
  • Altered consciousness
  • 3rd nerve palsy
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10
Q

What type of tumours cause hydrocephalus

A
  • Tumours in or close to CSF pathways
  • Especially posterior fossa tumours
  • Especially in children
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11
Q

How are brain tumours diagnosed

A
  • History and examination
  • Sources of secondary tumours (CXR)
  • CT scan
  • MRI scan
  • Biopsy
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12
Q

Describe symptoms of focal neurological deficit

A
  • Hemiparesis
  • Dysphasia
  • Hemianopia
  • Cognitive impairment (memory, sense of direction)
  • Cranial nerve palsy
  • Endocrine disorders- pituitary
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13
Q
  1. A 66 year old, left handed, woman presents with ataxia and in-coordination. Where would you suspect her lesion to be?
A

Cerebellum

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14
Q
  1. A 44 year old, right handed, woman presents with acalculia, agraphia, finger agnosia and right/left confusion. Where would you suspect her lesion to be?
A

Left parietal lobe

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15
Q
  1. A 30 year old, right handed, man presents with a bi temporal hemianopia. Where would you suspect his lesion to be?
A

Pituitary

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16
Q
  1. 50 year old right handed man
    • Presented to medical team with cognitive language dysfunction:
    • difficulty reading e mails
    • difficulty expressing what he wished to say
    • short-term memory impairment
    • 6-week history of posterior rib pain
    • PMHx included a left nephrectomy for renal cell carcinoma 5 years previously
    • Where do you think the lesion is?
A

Left temporo-parietal area, Primary Renal cell carcinoma

17
Q
  1. Lesion is cerebellum- most likely to be?
A

Meningioma- surgical excision (usually benign)

18
Q
  1. 50-year old woman
    4th October presented to ED with decreased level of consciousness
    o 1/12 of “slowing down”
    o making uncharacteristic mistakes at work
    o 4-day history of drowsiness
    o headache and nauseated
    o PMH - Nil
    o No allergies, no medications
    o Smokes pkt cigarettes/day, minimal alcohol
    o Worked as a dog catcher
    o Estranged from husband and lived with 19 year old daughter
    o GSC 11 e3v3m5
    o Pupils equal and reactive to light
    o No apparent focal neurological signs
    o Mild pyrexia (37.5°C)
    o Examination of chest/abdomen/breast normal
    o No palpable lymphadenopathy or skin lesions
    What investigation would you do next?
    Why not do a LP?
    What is the diagnosis?
A

CT/MRI
You might cause a herniation syndrome and the patient could die- coning
GBM

19
Q

When would you carry out a PET

A

When primary is unknown

20
Q

What are the management goals for brain tumour treatment

A 
•	Accurate tissue diagnosis
•	Improve quality of life
o	Decreasing mass effect
o	Improve neurological deficit
•	Aid effect of adjuvant therapy
•	Prolong life expectancy
21
Q

Treatment for brain tumours include

A
  • Corticosteroids
  • Treat epilepsy (anticonvulsant drugs)
  • Analgesics/antiemetics
  • Counselling
  • Surgery
  • Radiotherapy
  • Chemotherapy
  • Endocrine Replacement
22
Q

Management options of GBM

A 
–	complete surgical excision impossible
•	biopsy or debulk only
–	medical
•	Steroids
•	anticonvulsants
–	radiotherapy
–	chemotherapy- temazolamide
23
Q

Management for metastasis

A

most important to conform diagnosis
– Steroids, anticonvulsants
– Radiotherapy- whole brain/steriotatic
– Surgery

24
Q

Prognosis of meningioma

A

commonly cured by surgery may require anticonvulsants

25
Q

prognosis of low grade astrocytoma

A

Long life expectancy

26
Q

Prognosis of High grade/GBM

A

Average 1-year survival

Neurology (44 decks)

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