Neoplasm Flashcards
neuroanatomy
supratentorial (cerebral) vs. infratentorial (brain stem, cerebellum)
glial cells vs non glial
infratentorial signs
brain stem
pineal region
third and fourth ventricle
cerebellum
glial cells
astrocytes, oligodendrocytes, ependymal cells
non-glial
meninges, vessels, neurons, neuron stem cell glands
supratentorial findings
frontal lobe-personality changes (disinhibition lack of judgement, abulia), apraxia, aphasia, gaze preference, seizures
temporal lobe-seizures, memory, visual field cuts, aphasia
parietal lobe-contralateral sensory loss, aphasia, hemineglect or spatial disruption
occipital lobe-homonynous hemianopsia
infratentorial findings
brainstem-CN signs, hemiplegia, sensory loss, vertigo, nausea, vomiting, hydrocephalus
pineal region-hydrocephalus, parinaud syndrome
third ventricle-hydrocephalus, hypothalamic dysfunction, impaired memory
cerebellum-occipital HA, ataxia, hemiplegia, CN signs
CNS neoplasms
heterogeneous
affect pediatric and adults
mostly sporadic, unknown cause
key diagnostic distinctions
primary or secondary
benign or malignant
key signs
HA, seizures, focal neuro signs, non specific cognitive and personality changes
HA
non-specific and intermittent
progressively more intense and longer
exacerbated by coughing, lying down, sleep
wake up at night
SNOOPPPP
systemic symptoms neurologic symptoms or signs onset: abrupt, peak 50 yrs previous headache hx postural, positional precipitated by valsalva, exertion, etc. papilledema
primary brain tumors-clinical findings
usually subacute and gradual onset
present sx: HA, seizures, altered mental status
astrocytoma
half of all CNS tumors
grade I to grade II to anaplastic to grade IV
pathogenesis-arise from glial cells or neuroprogenitor stem cells, invade the brain tissue
astrocytoma-clinical findings
location-majority are supratentorial (cerebral, lateral ventricles, pineal region, third ventricle)
HA, seizures, progressive neuro deficits
disease course-varible based on type
astrocytoma-diagnosis
diagnostic studies
- hypodense on CT
- hypointense to isointense on MRI
- higher grade enhance with contrast and central area of hypodensity
- biopsy
astrocytoma-treatment
malignant- surgry radiation, chemotherapy
lower grade-observation, surgical resection, radiation
gene therapy
astrocytoma-prognosis
GBM-median survival of 1 yr
predictors-age (
meningioma
most common benign brain tumor
pathogenesis- arise from arachnoidal cap cells of the dura, rarely invade brain tissue
meningioma-clinical findings
common locations-most supratentorial; cerebral, cerebellar, or brain stem, pineal region, cerebello, pontine angle, sellar region
HA, seizures, progressive neuro deficits, slow growing
meningioma-disease course
insidious, gradual worsening
- initial symptoms: often HA
- no change, or very gradual change over mos to yrs
- worsening symptoms and function/present for treatment
- surgical removal
- cont’ to monitor for tumor growth or reoccurence
meningioma-diagnosis
CT:isodense or hyperdense
MRI:isotense on T1, brightly and uniformly enhance with contrast
meningioma-treatment & prognosis
total surgical resection is goal
favorable, relate to extent of resection
metastatic brain tumors
lung>breast>melanoma>GI
older adults
most supratentorial
metastatic brain tumors-pathogenesis
most contain the same type of cell of the primary CA, spread through blood stream
metastatic: S/S
HA>mental status>focal neurologic deficits
metastatic-diagnosis
MRI/CT
- multiple lesions
- grey-white junction
- enhance with contrast
- edema
metastatic-treatment/prognosis
poor: survival of 1 mo w/out treatment radiation-3-6 mos surgical removal-10 mos radiosurgery-14.1 mos emergent surgical resection
astrocytoma-etiology
arise from astrocytes
meningioma-etiology
from arachnoidal cap cells of meinges
metastatic-etiology
metastes from systemic CA
