Neoplasms and ALS Flashcards
How does a brain tumor commonly present?
subacute progression of focal neurological deficit
seizure
nonfocal neurological deficit
Subacute progression of focal neurological deficit d/t?
the tumor pressing down on the white matter
Seizure d/t?
disruption of neuronal circuits
Nonfocal neurological deficit - sx?
HA dementia personality disorders (esp if in the frontal lobe) gait disturbances (cerebellar) increased ICP N&V
HA types from nonfocal neurological deficit?
recumbency
increased ICP
Recumbency HA?
worse when resting
d/t displacement of pain-sensitive structure
Increased ICP HA?
happens many times a day
fast on, fast off
Brain tumor - tx?
symptomatic care
glucocorticoids- decrease edema (Dexa)
antiseizure (Keppra)
radiation
What do watch out for Dexa?
Cushing’s dz
What is a primary brain tumor?
glioma
What is glioma?
any brain tumor that arises from glial cell
What are the different types of glioma?
CNS lymphoma Oligoendroglimoa Meningioma Ependyoma Pituitary tumor Astrocytoma Schwannaoma Pnet
What is the most common brain tumor?
astrocytoma
Astrocytoma - pathophysio?
damages the brain tissues first
Astrocytoma - prognosis?
not good - cannot excise entirely
Astrocytoma - histological grades?
Grade I - IV (low and high)
Astrocytoma - low grade?
children> adults
cerebellum
grade I has good prognosis AFTER excision
grade II has 5-6 yr survival AFTER excision
Astoryctoma - high grade?
adult> children
supratentorium
grade IV astrocytoma: survival <1yr
Subtype of astrocytoma?
glioblastoma/glioblastoma multiforme
Astrocytoma -tx?
if not able to surgically remove (like high grade) - symptomatic:
glucocorticosteroids- Dexa
antiseizure - Keppra
radiation/chemo
Oligodendraglioma - prognosis?
a little benign- actually have a chance at surviving (longer life expectancy): excisable and respond well to chemo
Ependymomas - location?
intracranially spinal cord (filum terminale)
Ependymomas - tx?
excision; if able to? good prognosis - but usually deadly
Medullablastoma and primitive neuroectodermal tumors?
DEADLY AND AGGRESSIVE
Medullablastoma and primitive neuroectodermal tumors - location? population?
posterior fossa; neural precurosr cell
children
CNS lymphomas - types?
primary
secondary
CNS lymphomas primary - population?
immunocompromised patients - HIV pts
poor prognosis
CNS lymphomas secondary - population?
B cell lymphoma pts or B cell leukemia who have tumor of the bone, bone marrow, cranial sinus
CNS lymphomas primary and secondary - tx?
systemic chemo
intrathecal chemo/radiation
Meningioma?
benign tumor that starts at the mesoderm (attached to dura) and make it’s way into the brain
Meningioma - population?
females
mid age
Meningioma - areas?
sagittal sinus
cerebellar pontine
dorsum of spinal cord
Schwannoma?
arises from schwan cells
Schwannoma - area?
8th CN - acoustic
aka vestibular schwannnoma
Schwannoma - sx?
unilateral hearing loss
+/- compress facial nerve (CN VII) - facial palsy
Schwannoma - tx?
excision
hearing is lost
Pituitary tumor/adenoma?
benign tumor
Type of pituitary tumor/adenoma?
carniopharyngioma
Carniopharyngioma?
arises from Rathke’s pouch
Carniopharyngioma - sx?
HA
visual field defect
hypopituitarism
What are secondary/metastatic brain tumors?
cancer starts from somewhere else but makes it’s way up to the brain
Secondary/metastatic brain tumors - most common?
lung breast melanoma renal cancer colon cancer
Secondary/metastatic brain tumors - tx?
glucocorticosteroids
anticonvulsants
surgery
radiation/chemo
What is neurofibromatosis?
benign peripheral nerve tumors
schwann cells + fibroblasts
Type I von recklinghausen disease?
type of neurofibromatosis
cafe au lait spots
freckles in NON EXPOSED spots
nothing until it cxs radiculopathy
Tuberous sclerosis?
INHERITED
cutaneous lesions on the skin
Morton’s neuroma?
neuroma of plantar nerve (3rd and 4th metatarsal)
Morton neuroma - sx?
burning
something stuck in shoe
Morton neuroma - tx?
footwear change
steroid injection
neuroablation
surgical excision
What is ALS?
progressive weakness and paralysis of VOLUNTARY muscles
death of both UMN and LMN
What is the prognosis of ALS?
not good - pneumonia will kill them b/c they cannot cough up the phlegm
3-5 yrs of survival
ALS - population?
40-60 yrs
ALS - sx?
insidious
NO PAIN AND NO SENSORY LOSS
limb weakness first»_space;> painless difficulty turning keys/buttons (dexterity)
speech/swallowing difficulties
ALS - what is spared?
occular muscles
bladder, bowel, sexual fxn
ALS - PE?
LMN - weakness, atrophy, fasciculation
UMN - hyperreflexia, babinski sign spasticity
ALS - dx?
expert needed
MRI may be used to r/o
ALS -tx?
nothing baclofen for spasms family counsel \+/- vent/tracheostomy \+/-gastrostomy PT
