Mass Lesions Flashcards
primary CNS tumors
common in childhood
high incidence 65-74
children: typically below tantrum (adults opposite)
why do symptoms develop from primary CNS tumors? (6)
- destruction
- space occupying (increased ICP)
- blocking flow (hydrocephalus)
- angiogenesis (disrupts BBB)
- decreased blood supply (compromised perfusion)
- herniation (increased ICP)
risk factors for primary CNS tumor
history of radiation to head
genetically inherited dz
HIV (CNS lymphoma is AIDS defining)
symptoms fo primary CNS tumor
slowly progressive (symptomatic late)
- HA (tension, worse @nite)
- personality/mood change, cognitive impairment
- decreased appetite or nausea
- seizures
- diplopia
signs of primary CNS tumor
cognitive dysfunciton
weakness
sensory loss
aphasia/apraxia
diagnostic SOC primary CNS tumor
MRI + contrast
can CT, PET, biopsy
types of primary tumors (9)
- glioblastoma multiforme
- astrocytoma
- meningioma
- CNS lymphoma
- acoustic neuroma
- oligodendrogliomas
- ependymomas
- pituitary adenomas
- primitive neuorectodermal tumors
glioblastoma multiforme
MC, most progressive
rapidly progressive, adults and cerebral hemispheres
arise de nova, develop from lower grade
fatal in 3 mo, optimal: CXT/XT 12mo
astrocytoma
agressive or indolently, but typically advanced grade
adults, cerebral invasion, symptoms by invasion/compression/destruction
sx,XT, CXT all considered
meningiomas
contiguous with meningitis, 90% benign
typically compress and irritate tissue = seizure
recur if not recited completely
XT or Sx only
CNS lymphoma
B cell NHL, solitery lesions
can be in immunocompetent or immunocompromised – esp. IVDA/HIV +
responsive to methotrexate and chemo/radiation
avoid steroids
acoustic neuroma
extra axial tumors of vestibular/choclear nerves
large before symptomatic
ipsilateral hearing loss, tinnitus, vertigo, HA, weakness
curable with excisions
oligodenrogliomas
young - middle age adults
good prognosis
ependymomas
intraventricular masses with extension in subarachnoid space
pituitary adenomas
chemically active or destruction
macro adenoma, micro adenoma
visual disturbance common (optic chasm)
primitive neuorextodermal tumors
posterior fossa
spreads widely
surgical tx primary CNS tumor
done with intent to cure
no spread
when is surgery CI
brainstem tumor
high risk of debilitating neuro dysfunction
lesions are muslticola
gamma knife
radiosurgery
multiple radiation beams sent in and converge on one location
zaps tumor
medical tx of primary CNS tumor
high dose steroids (decrease edema, decadron)
AED
radiation/chemo (CXT not used bc can’t cross BB)
mc sources of CNS mets
lung breast kidney melanoma GI
why are mets more likely to have acute symptoms
more rapid growth
mor vasogenic edema
more likely to hemorrhage
diagnosis of cns mets
MRI w/ and w.o contrast
tx of CNS met
single: surgery + XT
multiple: discussion of prognosis
