Neoplasm

Question 1

neuroanatomy

Answer 1

supratentorial (cerebral) vs. infratentorial (brain stem, cerebellum)
glial cells vs non glial

Question 2

infratentorial signs

Answer 2

brain stem
pineal region
third and fourth ventricle
cerebellum

Question 3

glial cells

Answer 3

astrocytes, oligodendrocytes, ependymal cells

Question 4

non-glial

Answer 4

meninges, vessels, neurons, neuron stem cell glands

Question 5

supratentorial findings

Answer 5

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

Question 6

infratentorial findings

Answer 6

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

Question 7

CNS neoplasms

Answer 7

heterogeneous
affect pediatric and adults
mostly sporadic, unknown cause

Question 8

key diagnostic distinctions

Answer 8

primary or secondary

benign or malignant

Question 9

key signs

Answer 9

HA, seizures, focal neuro signs, non specific cognitive and personality changes

Question 10

HA

Answer 10

non-specific and intermittent
progressively more intense and longer
exacerbated by coughing, lying down, sleep
wake up at night

Question 11

SNOOPPPP

Answer 11

systemic symptoms
neurologic symptoms or signs
onset: abrupt, peak 50 yrs
previous headache hx
postural, positional
precipitated by valsalva, exertion, etc.
papilledema

Question 12

primary brain tumors-clinical findings

Answer 12

usually subacute and gradual onset

present sx: HA, seizures, altered mental status

Question 13

astrocytoma

Answer 13

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

Question 14

astrocytoma-clinical findings

Answer 14

location-majority are supratentorial (cerebral, lateral ventricles, pineal region, third ventricle)
HA, seizures, progressive neuro deficits
disease course-varible based on type

Question 15

astrocytoma-diagnosis

Answer 15

diagnostic studies

• hypodense on CT
• hypointense to isointense on MRI
• higher grade enhance with contrast and central area of hypodensity
• biopsy

Question 16

astrocytoma-treatment

Answer 16

malignant- surgry radiation, chemotherapy
lower grade-observation, surgical resection, radiation
gene therapy

Question 17

astrocytoma-prognosis

Answer 17

GBM-median survival of 1 yr

predictors-age (

Question 18

meningioma

Answer 18

most common benign brain tumor

pathogenesis- arise from arachnoidal cap cells of the dura, rarely invade brain tissue

Question 19

meningioma-clinical findings

Answer 19

common locations-most supratentorial; cerebral, cerebellar, or brain stem, pineal region, cerebello, pontine angle, sellar region
HA, seizures, progressive neuro deficits, slow growing

Question 20

meningioma-disease course

Answer 20

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

Question 21

meningioma-diagnosis

Answer 21

CT:isodense or hyperdense
MRI:isotense on T1, brightly and uniformly enhance with contrast

Question 22

meningioma-treatment & prognosis

Answer 22

total surgical resection is goal

favorable, relate to extent of resection

Question 23

metastatic brain tumors

Answer 23

lung>breast>melanoma>GI
older adults
most supratentorial

Question 24

metastatic brain tumors-pathogenesis

Answer 24

most contain the same type of cell of the primary CA, spread through blood stream

Question 25

metastatic: S/S

Answer 25

HA>mental status>focal neurologic deficits

Question 26

metastatic-diagnosis

Answer 26

MRI/CT

• multiple lesions
• grey-white junction
• enhance with contrast
• edema

Question 27

metastatic-treatment/prognosis

Answer 27

poor: survival of 1 mo w/out treatment
radiation-3-6 mos
surgical removal-10 mos
radiosurgery-14.1 mos
emergent surgical resection

Question 28

astrocytoma-etiology

Answer 28

arise from astrocytes

Question 29

meningioma-etiology

Answer 29

from arachnoidal cap cells of meinges

Question 30

metastatic-etiology

Answer 30

metastes from systemic CA