Mass lesions-neoplasm Flashcards
Define meningioma.
A meningioma is a (usually benign) tumor that develops from coverings of the brian.
Name 3 types of gliomas.
1) Oligodendroglioma
2) Ependymoma
3) Astrocytoma
- Anaplastic astrocytoma is a high grade glial tumor that develops from astrocytes.
- Glioblastoma multiforme is a malignant glial tumor that develops from astrocytes.
What is a medullablastoma and who does it normally affect?
A medulloblastoma is a tumor that develops from primative neuroectodermal cells (usually in children).
What is a drop metastasis?
A drop metastasis is a metastasis, usually from glioblatomas or ependymomas, that occurs through the cerebrospinal system. it typically occurs around the lumbar nerve roots or the lower spinal cord.
Define myelopathy.
A myelopathy is damage to the spinal cord.
Define radiculopathy.
A radiculopathy is damage to a nerve root.
What is a paraneoplastic syndrome?
A paraneoplastic syndrome is a syndrome, usually from development of an autoimmune reaction, where there is damage to neural structures.
How are tumors localized?
Tumors are localized by their focal effects on the brain.
What are the signs that localize tumors?
- Cortical signs: aphasia, hemiparesis, hemianopsia/quadrantanopsia, sensory loss, parietal lobe symptoms (neglect, agnosia), frontal lobe signs (dysinhibition, apathy personality change)
- Cerebellar: incoordination, ataxia
- Lateral brain stem: unilateral loss of pin and temperature sense on face
- Brain stem: cranial nerve palsy
- Loss of up gaze: dorsal brain stem, pineal region
- Bitemporal hemianopsia: pituitary region
- Spinal cord: saddle anesthesia, paraplegia, sphincter dysfunction
What are some irritative signs of tumors of the nervous system?
- Radiculopathy is due to irritation of the nerve roots.
- A significant percentage of brain tumors present with seizure when they irritate the cerebral cortex.
What are the signs and symptoms of increased intracranial pressure that can be found in brain tumors?
- Awakened from sleep by headache.
- Papilledema or loss of venous pulsations in fundus of eye may be observed.
- Cushing response (increase BP with decrease pulse)
- Signs of herniation (there are several types: subfalcine/cingulate, transtentorial, cerebellar).
- Transtentorial herniation => dilating pupil (usually ipsilateral) and hemiparesis (usually contralateral).
What signs and symptoms are common in tumors of the pituitary region?
Endocrine problems or bitemporal hemianopsia are common with tumors of the pituitary region.
What signs and symptoms are common in tumors of the pineal region?
Failure of upgaze (Parenaud’s syndrome) may be seen with pineal/tectal region neoplasms.
Why do symptoms of brain tumors often respond to steroids?
Brain tumors, especially metastatic ones, often result in severe vasogenic edema.
- This type of tumor often responds to steroids with some inprovement in symptoms.
What are the types of primary brain tumors?
- Glioma
- Ependymoma
- Meningioma
- Lymphoma (either primary or spread from elsewhere)
- Schwanoma
- Pituitary adenoma
- Primitive neuroectodermal tumor
- Pinealoma
Why is it usually impossible to cure a glioma?
Gliomas often infiltrate the brain so complete resection is impossible.
What glioma is usually resectible?
Cerebellar astrocytoma (pilocytic astrocytoma) in children are usually benign and resectable if found early.
What tumors are primarily localized to the posterior fossa?
- Many childhood brain tumors are localized to the posterior fossa.
- Ependymoma, astrocytoma, medulloblastoma
- Other posterior fossa tumors
- Meningioma, ependymoma, acoustic neuroma (Schwanoma), cerebellar hemangioblastoma
Which astrocytoma has a good prognosis?
Cerebellar astrocytoma (Pilocytic astrocytoma) - pediatric tumor
Which brainstem tumors have poor prognoses?
- Pontine glioma
- Medulloblastoma
What are the treatments for brain tumors?
- Surgical resection is possible for benign tumors like meningioma and sometimes for solitary metastasis (if the systemic cancer controllable).
- Chemotherapy is limited by the blood-brain barrier and only specific types can be used.
- Sometimes chemotherapeutic agents can be delivered to the intrathecal space.
- Radiation is often useful for treatment, but it can damage the brain, especially long-term.
What are non-metastatic complications to systemic cancers?
- Neurologic symptoms
- symptoms can be related to a stroke, an infection, side effects of treatment , paraneoplastic syndrome.
- Subacute cerebellar syndrome
- Polyneuropathy
- Myoneural junction disease (weakness)
- Confusional state.
What is the most common cause of tumors of the spine?
Most tumors of the spine are metastatic.
What are the common signs and symptoms of metastatic tumors of the spine?
- Back pain
- Acute or subacute myelopathy (initially flaccid weakness, upgoing toes, sensory level over the trunk, bladder and bowel dysfunction)
- Possible radiculopathy at the level of the tumor.
*The level of back pain and the radiculopathy are the most predictive of the location of the tumor.
