Mass Lesions

Question 1

primary CNS tumors

Answer 1

common in childhood

high incidence 65-74

children: typically below tantrum (adults opposite)

Question 2

why do symptoms develop from primary CNS tumors? (6)

Answer 2

1. destruction
2. space occupying (increased ICP)
3. blocking flow (hydrocephalus)
4. angiogenesis (disrupts BBB)
5. decreased blood supply (compromised perfusion)
6. herniation (increased ICP)

Question 3

risk factors for primary CNS tumor

Answer 3

history of radiation to head

genetically inherited dz

HIV (CNS lymphoma is AIDS defining)

Question 4

symptoms fo primary CNS tumor

Answer 4

slowly progressive (symptomatic late)

1. HA (tension, worse @nite)
2. personality/mood change, cognitive impairment
3. decreased appetite or nausea
4. seizures
5. diplopia

Question 5

signs of primary CNS tumor

Answer 5

cognitive dysfunciton

weakness

sensory loss

aphasia/apraxia

Question 6

diagnostic SOC primary CNS tumor

Answer 6

MRI + contrast

can CT, PET, biopsy

Question 7

types of primary tumors (9)

Answer 7

1. glioblastoma multiforme
2. astrocytoma
3. meningioma
4. CNS lymphoma
5. acoustic neuroma
6. oligodendrogliomas
7. ependymomas
8. pituitary adenomas
9. primitive neuorectodermal tumors

Question 8

glioblastoma multiforme

Answer 8

MC, most progressive

rapidly progressive, adults and cerebral hemispheres

arise de nova, develop from lower grade

fatal in 3 mo, optimal: CXT/XT 12mo

Question 9

astrocytoma

Answer 9

agressive or indolently, but typically advanced grade

adults, cerebral invasion, symptoms by invasion/compression/destruction

sx,XT, CXT all considered

Question 10

meningiomas

Answer 10

contiguous with meningitis, 90% benign

typically compress and irritate tissue = seizure

recur if not recited completely

XT or Sx only

Question 11

CNS lymphoma

Answer 11

B cell NHL, solitery lesions

can be in immunocompetent or immunocompromised – esp. IVDA/HIV +

responsive to methotrexate and chemo/radiation

avoid steroids

Question 12

acoustic neuroma

Answer 12

extra axial tumors of vestibular/choclear nerves

large before symptomatic

ipsilateral hearing loss, tinnitus, vertigo, HA, weakness

curable with excisions

Question 13

oligodenrogliomas

Answer 13

young - middle age adults

good prognosis

Question 14

ependymomas

Answer 14

intraventricular masses with extension in subarachnoid space

Question 15

pituitary adenomas

Answer 15

chemically active or destruction

macro adenoma, micro adenoma

visual disturbance common (optic chasm)

Question 16

primitive neuorextodermal tumors

Answer 16

posterior fossa

spreads widely

Question 17

surgical tx primary CNS tumor

Answer 17

done with intent to cure

no spread

Question 18

when is surgery CI

Answer 18

brainstem tumor
high risk of debilitating neuro dysfunction
lesions are muslticola

Question 19

gamma knife

Answer 19

radiosurgery

multiple radiation beams sent in and converge on one location

zaps tumor

Question 20

medical tx of primary CNS tumor

Answer 20

high dose steroids (decrease edema, decadron)

AED

radiation/chemo (CXT not used bc can’t cross BB)

Question 21

mc sources of CNS mets

Answer 21

lung
breast 
kidney 
melanoma 
GI

Question 22

why are mets more likely to have acute symptoms

Answer 22

more rapid growth
mor vasogenic edema
more likely to hemorrhage

Question 23

diagnosis of cns mets

Answer 23

MRI w/ and w.o contrast

Question 24

tx of CNS met

Answer 24

single: surgery + XT
multiple: discussion of prognosis

Question 25

primary CA metastasis to meninges and cord

Answer 25

leptomeningeal mass

Question 26

MC primaries of leptomeningeal mass

Answer 26

breast
lymphoma
leukemia

Question 27

symptoms leptomeningeal mass

Answer 27

ataxia/gait changes 
HA
disturbed sensorium
memory issues 
incontinence

Question 28

diagnostics of leptomeningeal mass

Answer 28

LP, CT, MRI

Question 29

tx leptomeningeal mass

Answer 29

poor prognosis

sz for planet of ommaya pump
XT, Cath CXT