Lecture 37 Brain Tumours (Clinical) Flashcards
Name primary tumours
Glioma
Meningioma
Pituitary
What are the commonest tumours that spread to the brain
- Renal cell carcinoma
- Lung carcinoma
- Breast carcinoma
- Malignant melanoma
- GI tract
Where are gliomas derived from
Astrocytes- structural and nutritional support of nerve cells
Describe Gliomas
• 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
Describe Meningiomas
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
Describe Pituitary tumours
• Adenoma most common • Only 1% tumours malignant • Presentation – visual disturbance • compression of optic chiasm – hormone imbalance
Clinical presentation of brain tumours
- Raised ICP
- Focal neurological deficit
- Epileptic fits
- CSF obstruction
Raised ICP symptoms
- Headache- morning due to reduced venous return leading to venous congestion
- Nausea/vomiting- hyperventilation
- Visual disturbance (diplopia, blurred vision)
- Somnolence
- Cognitive impairment
- Altered consciousness
Raised ICP signs
- Papilloedema
- 6th nerve palsy- Abducens- longest course
- Cognitive impairment
- Altered consciousness
- 3rd nerve palsy
What type of tumours cause hydrocephalus
- Tumours in or close to CSF pathways
- Especially posterior fossa tumours
- Especially in children
How are brain tumours diagnosed
- History and examination
- Sources of secondary tumours (CXR)
- CT scan
- MRI scan
- Biopsy
Describe symptoms of focal neurological deficit
- Hemiparesis
- Dysphasia
- Hemianopia
- Cognitive impairment (memory, sense of direction)
- Cranial nerve palsy
- Endocrine disorders- pituitary
- A 66 year old, left handed, woman presents with ataxia and in-coordination. Where would you suspect her lesion to be?
Cerebellum
- 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?
Left parietal lobe
- A 30 year old, right handed, man presents with a bi temporal hemianopia. Where would you suspect his lesion to be?
Pituitary
- 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?
Left temporo-parietal area, Primary Renal cell carcinoma
- Lesion is cerebellum- most likely to be?
Meningioma- surgical excision (usually benign)
- 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?
CT/MRI
You might cause a herniation syndrome and the patient could die- coning
GBM
When would you carry out a PET
When primary is unknown
What are the management goals for brain tumour treatment
• Accurate tissue diagnosis • Improve quality of life o Decreasing mass effect o Improve neurological deficit • Aid effect of adjuvant therapy • Prolong life expectancy
Treatment for brain tumours include
- Corticosteroids
- Treat epilepsy (anticonvulsant drugs)
- Analgesics/antiemetics
- Counselling
- Surgery
- Radiotherapy
- Chemotherapy
- Endocrine Replacement
Management options of GBM
– complete surgical excision impossible • biopsy or debulk only – medical • Steroids • anticonvulsants – radiotherapy – chemotherapy- temazolamide
Management for metastasis
most important to conform diagnosis
– Steroids, anticonvulsants
– Radiotherapy- whole brain/steriotatic
– Surgery
Prognosis of meningioma
commonly cured by surgery may require anticonvulsants
