Mass lesions-neoplasm

Question 1

Define meningioma.

Answer 1

A meningioma is a (usually benign) tumor that develops from coverings of the brian.

Question 2

Name 3 types of gliomas.

Answer 2

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.

Question 3

What is a medullablastoma and who does it normally affect?

Answer 3

A medulloblastoma is a tumor that develops from primative neuroectodermal cells (usually in children).

Question 4

What is a drop metastasis?

Answer 4

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.

Question 5

Define myelopathy.

Answer 5

A myelopathy is damage to the spinal cord.

Question 6

Define radiculopathy.

Answer 6

A radiculopathy is damage to a nerve root.

Question 7

What is a paraneoplastic syndrome?

Answer 7

A paraneoplastic syndrome is a syndrome, usually from development of an autoimmune reaction, where there is damage to neural structures.

Question 8

How are tumors localized?

Answer 8

Tumors are localized by their focal effects on the brain.

Question 9

What are the signs that localize tumors?

Answer 9

• 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

Question 10

What are some irritative signs of tumors of the nervous system?

Answer 10

• Radiculopathy is due to irritation of the nerve roots.

- A significant percentage of brain tumors present with seizure when they irritate the cerebral cortex.

Question 11

What are the signs and symptoms of increased intracranial pressure that can be found in brain tumors?

Answer 11

• 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).

Question 12

What signs and symptoms are common in tumors of the pituitary region?

Answer 12

Endocrine problems or bitemporal hemianopsia are common with tumors of the pituitary region.

Question 13

What signs and symptoms are common in tumors of the pineal region?

Answer 13

Failure of upgaze (Parenaud’s syndrome) may be seen with pineal/tectal region neoplasms.

Question 14

Why do symptoms of brain tumors often respond to steroids?

Answer 14

Brain tumors, especially metastatic ones, often result in severe vasogenic edema.
- This type of tumor often responds to steroids with some inprovement in symptoms.

Question 15

What are the types of primary brain tumors?

Answer 15

• Glioma
• Ependymoma
• Meningioma
• Lymphoma (either primary or spread from elsewhere)
• Schwanoma
• Pituitary adenoma
• Primitive neuroectodermal tumor
• Pinealoma

Question 16

Why is it usually impossible to cure a glioma?

Answer 16

Gliomas often infiltrate the brain so complete resection is impossible.

Question 17

What glioma is usually resectible?

Answer 17

Cerebellar astrocytoma (pilocytic astrocytoma) in children are usually benign and resectable if found early.

Question 18

What tumors are primarily localized to the posterior fossa?

Answer 18

• Many childhood brain tumors are localized to the posterior fossa.
  
  • Ependymoma, astrocytoma, medulloblastoma
• Other posterior fossa tumors
  
  • Meningioma, ependymoma, acoustic neuroma (Schwanoma), cerebellar hemangioblastoma

Question 19

Which astrocytoma has a good prognosis?

Answer 19

Cerebellar astrocytoma (Pilocytic astrocytoma)
   - pediatric tumor

Question 20

Which brainstem tumors have poor prognoses?

Answer 20

• Pontine glioma

- Medulloblastoma

Question 21

What are the treatments for brain tumors?

Answer 21

• 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.

Question 22

What are non-metastatic complications to systemic cancers?

Answer 22

• 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.

Question 23

What is the most common cause of tumors of the spine?

Answer 23

Most tumors of the spine are metastatic.

Question 24

What are the common signs and symptoms of metastatic tumors of the spine?

Answer 24

• 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.

Question 25

Why is it critical to identify malignant spinal cord compression early?

Answer 25

It is critical to identify malignant spinal cord compression early because the outcome of treatment depends on the severity of deficit at the beginning of therapy.

Question 26

What is the standard therapy for spinal cord metastatic disease?

Answer 26

High-dose steroids are often helpful along with radiation therapy are the common initial measures.
- These may be used with or without surgery

Question 27

What are the primary tumors of the spine?

Answer 27

• Rare primary tumors of nerve root
  
  • Nneurofibromas, Schwanomas, meningiomas, gliomas.
• Rare tumors inside the spinal cord
  
  • ependymoma and glioma.

Question 28

How can you evaluate possible metastatic disease affecting the nervous system?

Answer 28

• MRI&raquo_space; CT scans at detecting metastasis
• CT scans are not very effective unless there is destruction of bone.
• Plain x-rays are useful when the metastasis involves bone. - Tissue diagnosis is critical to determine the type of tumor.
  
  • In the future MR spectroscopy holds promise for noninvasive diagnosis.