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Neurology > Neoplasms and ALS > Flashcards

Neoplasms and ALS Flashcards

1
Q

How does a brain tumor commonly present?

A

subacute progression of focal neurological deficit
seizure
nonfocal neurological deficit

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2
Q

Subacute progression of focal neurological deficit d/t?

A

the tumor pressing down on the white matter

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3
Q

Seizure d/t?

A

disruption of neuronal circuits

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4
Q

Nonfocal neurological deficit - sx?

A 
HA
dementia
personality disorders (esp if in the frontal lobe)
gait disturbances (cerebellar)
increased ICP
N&V
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5
Q

HA types from nonfocal neurological deficit?

A

recumbency

increased ICP

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6
Q

Recumbency HA?

A

worse when resting

d/t displacement of pain-sensitive structure

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7
Q

Increased ICP HA?

A

happens many times a day

fast on, fast off

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8
Q

Brain tumor - tx?

A

symptomatic care
glucocorticoids- decrease edema (Dexa)
antiseizure (Keppra)
radiation

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9
Q

What do watch out for Dexa?

A

Cushing’s dz

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10
Q

What is a primary brain tumor?

A

glioma

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11
Q

What is glioma?

A

any brain tumor that arises from glial cell

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12
Q

What are the different types of glioma?

A 
CNS lymphoma
Oligoendroglimoa 
Meningioma
Ependyoma
Pituitary tumor
Astrocytoma
Schwannaoma
Pnet
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13
Q

What is the most common brain tumor?

A

astrocytoma

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14
Q

Astrocytoma - pathophysio?

A

damages the brain tissues first

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15
Q

Astrocytoma - prognosis?

A

not good - cannot excise entirely

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16
Q

Astrocytoma - histological grades?

A

Grade I - IV (low and high)

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17
Q

Astrocytoma - low grade?

A

children> adults
cerebellum
grade I has good prognosis AFTER excision
grade II has 5-6 yr survival AFTER excision

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18
Q

Astoryctoma - high grade?

A

adult> children
supratentorium
grade IV astrocytoma: survival <1yr

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19
Q

Subtype of astrocytoma?

A

glioblastoma/glioblastoma multiforme

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20
Q

Astrocytoma -tx?

A

if not able to surgically remove (like high grade) - symptomatic:
glucocorticosteroids- Dexa
antiseizure - Keppra
radiation/chemo

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21
Q

Oligodendraglioma - prognosis?

A

a little benign- actually have a chance at surviving (longer life expectancy): excisable and respond well to chemo

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22
Q

Ependymomas - location?

A 
intracranially
spinal cord (filum terminale)
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23
Q

Ependymomas - tx?

A

excision; if able to? good prognosis - but usually deadly

24
Q

Medullablastoma and primitive neuroectodermal tumors?

A

DEADLY AND AGGRESSIVE

25
Q

Medullablastoma and primitive neuroectodermal tumors - location? population?

A

posterior fossa; neural precurosr cell

children

26
Q

CNS lymphomas - types?

A

primary

secondary

27
Q

CNS lymphomas primary - population?

A

immunocompromised patients - HIV pts

poor prognosis

28
Q

CNS lymphomas secondary - population?

A

B cell lymphoma pts or B cell leukemia who have tumor of the bone, bone marrow, cranial sinus

29
Q

CNS lymphomas primary and secondary - tx?

A

systemic chemo

intrathecal chemo/radiation

30
Q

Meningioma?

A

benign tumor that starts at the mesoderm (attached to dura) and make it’s way into the brain

31
Q

Meningioma - population?

A

females

mid age

32
Q

Meningioma - areas?

A

sagittal sinus
cerebellar pontine
dorsum of spinal cord

33
Q

Schwannoma?

A

arises from schwan cells

34
Q

Schwannoma - area?

A

8th CN - acoustic

aka vestibular schwannnoma

35
Q

Schwannoma - sx?

A

unilateral hearing loss

+/- compress facial nerve (CN VII) - facial palsy

36
Q

Schwannoma - tx?

A

excision

hearing is lost

37
Q

Pituitary tumor/adenoma?

A

benign tumor

38
Q

Type of pituitary tumor/adenoma?

A

carniopharyngioma

39
Q

Carniopharyngioma?

A

arises from Rathke’s pouch

40
Q

Carniopharyngioma - sx?

A

HA
visual field defect
hypopituitarism

41
Q

What are secondary/metastatic brain tumors?

A

cancer starts from somewhere else but makes it’s way up to the brain

42
Q

Secondary/metastatic brain tumors - most common?

A 
lung
breast
melanoma
renal cancer
colon cancer
43
Q

Secondary/metastatic brain tumors - tx?

A

glucocorticosteroids
anticonvulsants
surgery
radiation/chemo

44
Q

What is neurofibromatosis?

A

benign peripheral nerve tumors

schwann cells + fibroblasts

45
Q

Type I von recklinghausen disease?

A

type of neurofibromatosis
cafe au lait spots
freckles in NON EXPOSED spots
nothing until it cxs radiculopathy

46
Q

Tuberous sclerosis?

A

INHERITED

cutaneous lesions on the skin

47
Q

Morton’s neuroma?

A

neuroma of plantar nerve (3rd and 4th metatarsal)

48
Q

Morton neuroma - sx?

A

burning

something stuck in shoe

49
Q

Morton neuroma - tx?

A

footwear change
steroid injection
neuroablation
surgical excision

50
Q

What is ALS?

A

progressive weakness and paralysis of VOLUNTARY muscles

death of both UMN and LMN

51
Q

What is the prognosis of ALS?

A

not good - pneumonia will kill them b/c they cannot cough up the phlegm
3-5 yrs of survival

52
Q

ALS - population?

A

40-60 yrs

53
Q

ALS - sx?

A

insidious
NO PAIN AND NO SENSORY LOSS
limb weakness first&raquo_space;> painless difficulty turning keys/buttons (dexterity)
speech/swallowing difficulties

54
Q

ALS - what is spared?

A

occular muscles

bladder, bowel, sexual fxn

55
Q

ALS - PE?

A

LMN - weakness, atrophy, fasciculation

UMN - hyperreflexia, babinski sign spasticity

56
Q

ALS - dx?

A

expert needed

MRI may be used to r/o

57
Q

ALS -tx?

A 
nothing
baclofen for spasms
family counsel
\+/- vent/tracheostomy
\+/-gastrostomy
PT

Neurology (13 decks)

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