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Neurology Module > Neoplasms of the Brain > Flashcards

Neoplasms of the Brain Flashcards

1
Q

Prevalence of Primary Brain Tumors

A

2% of all cancers

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2
Q

Peak incidence of Primary brain tumors

A

65-79

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3
Q

Men vs Women for Brain tumors

A

Men > Women for most tumors.

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4
Q

Risk factors for Brain Tumors

A

High dose ionizing radiation.

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5
Q

Signs and Symptoms of Brain Tumors

A 
Headaches
Seizures
Congitive/Personality Changes
Focal Weakness
N/V
Speech Difficulty
Visual Changes
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6
Q

PE findings for Brain Tumor

A

Papilledema
CN6 Palsy
Motor Exam
Gait disturbance

-Depends on brain tumor location.

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7
Q

Benign Brain Tumors

A

Meningioma (30%)
Pituitary Adenoma (5-10%)
Schwannoma (3-5%)
Craniopharyngioma (<2%)

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8
Q

Most common benign brain tumor

A

Meningioma

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9
Q

Malignant Brain Tumors

A 
Gliomas
Astrocytoma (18-20%)
Glioblastoma (35-40%)
Oligodendroglioma
Pineal tumor (2%)
Medulloblastoma (<1%)
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10
Q

Most common malignant brain tumor

A

Glioblastomas

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11
Q

“Other” Types of Brain Tumors

A

neurofibromatosis

metastatic tumors

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12
Q

Most common Pediatric Brain Tumors

A

Medulloblastoma

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13
Q

What are the most solid tumors in children?

A

Brain tumors

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14
Q

Brain tumor types in children

A 
Astrocytoma
Brain stem gliomas
Ependyoma
Craniopharyngioma
\+/- others
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15
Q

Most common type of brain tumor

A

Meningioma

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16
Q

Meningioma Women v Men

A

3:1

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17
Q

Where do meningiomas come from?

A

Arise from the meninges in the arachnoid space

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18
Q

What may be a problem with a meningioma in the intraventricular sinus?

A

Hydrocephalus

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19
Q

Which meningiomas are more difficult to remove?

A

Those in the base of the skull.

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20
Q

What problem would a meningioma in teh posterior fossa cause?

A

Cranial Nerve Palsies and issues

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21
Q

Diagnosis of Meningiomas

A

Distinct radiological characteristics

  • “dura tail”
  • Indentation of brain
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22
Q

Meningioma Grading

A

Grade I: Meningioma (85%)- benign

Grade II: Atypical meningioma (15%)
Neither cancerous, nor benign
Grow faster, recur

Grade III: Anaplastic meningioma (1-4%)
Malignant
Invasive

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23
Q

Benign Meningioma

A

Grade I

85%

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24
Q

Atypical Meningioma

A

Grade II
15%

Neither cancerous, nor benign
Grow faster, recur

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25
Q

Anaplastic Meningioma

A

Grade III
1-4%

Malignant
Invasive

26
Q

Treatment of Meningioma

A

Watchful waiting

Craniotomy

  • Remove as much of the tumor as possible
  • Location and size are factors

Radiation

  • Sterotactic radiation
  • “stereotactic radiosurgery”
  • “gamma knife”
27
Q

Familial Link of Pituitary Adenomas

A

Familial link- multiple endocrine neoplasia type 1 (MEN1)

28
Q

Pituitary adenomas account for _____% of tumors

A

10

29
Q

Presentation of pituitary adenomas depends on

A

type of cell abnormality

30
Q

Signs and Symptoms of Prolactinoma

A 
Lactotrophs
Gallactorrhea, gynecomastia
Suppression of LH:
Women:  infertility, amenorrhea
Men:  ED
31
Q

Most common pituitary adenoma.

A

Prolactinoma

32
Q

S/S Growth Hormone

A

Somatotrophs

Acromegaly

33
Q

S/S Nonfunctioning adenoma

A

No hormonal abnormalities

Compresses optic nerve

34
Q

S/S Adrenocorticotropin Hormone (ACTH)

A

corticotrophs

Cushing’s

35
Q

S/S LS/FSH pitutiary adenoma

A

gonadotrophs

36
Q

TSH Pituitary Adenoma

A

thyrotrophs
Increased TSH

Secondary Hyperthyroidism

37
Q

Pituitary Adenoma classified by

A

Size

38
Q

Pituitary Adenoma > or = 10 mm

A

Macroadenoma

39
Q

Pituitary Adenoma <10 mm

A

Microadenoma

40
Q

Treatment/Management of Pituitary Adenoma

A

Consult:
Endocrinology and Neurosurgery
Nonfunctioning: ophthalmology

Medical management

Surgical approach:
Minimally invasive endonasal endoscopic surgery

If surgery not option or recurrence:
Stereotactic- these tumors do not respond quickly to radiation and may take months to control

41
Q

Craniopharyngiomas occur near

A

the pituiatary gland.

42
Q

Craniopharyngiomas are classified as

A

a pituitary tumor

43
Q

How do Craniopharyngiomas differ from pituitary adenomas?

A

Adenomas arise from cells in the anterior lobe

Craniopharyngiomas arrive from cells in Rathke’s duct

Craniopharyngiomas have bimodal peak- ages 5-14 and 65-74

44
Q

S/S Craniopharyngiomas

A

May disrupt pituitary function
Optic nerve compression
Increased ICP

45
Q

Treatment of Craniopharyngioma

A

same as pituitary adenoma except usually subtotal excision + radiation (recurrence rate 15%)

46
Q

Peak age of Schannoma - Acoustic Neuroma

A

30-60

47
Q

Acoustic Neuroma occur on CN

A

CN VIII - Vestibulocochlear

48
Q

Characteristics of Schwannoma - Acoustic Neuroma

A

Benign but can cause serious, life threatening complications rarely (brain stem compression, hydrocephalus)

49
Q

Symptoms of Schwannoma-Acoustic Neuroma

A

Usually unilateral (except in neurofibromatosis2)

Hearing loss- unilateral
Tinnitus x 1 month or longer
Vertigo- episodic

Weber’s Test - lateralizes to good ear.
Rinne- BC>AC

50
Q

Imaging of Schwannoma-Acoustic Neuroma

A

MRI with attention to internal auditory canals

51
Q

Treatment of Schwannoma-Acoustic Neuroma

A

Surgery:

Keyhole surgery: Retromastoid/retrosigmoid craniotomy

Minimizes risk of damage to cranial nerve and preservation of hearing

52
Q

Malignancies arising from glial cells.

A

Gliomas

53
Q

Glial Cells Include

A

Astrocytes
Oligodendrocytes
Ependymal

54
Q

Functions of Astrocytes

A

Communicate with neurons
Supportive- nutrients
Blood brain barrier

55
Q

Functions of Oligodendrocytes

A

Wrap around axons

Myelinate

56
Q

Functions of Ependymal

A

Line Ventricles

Produce/Absorb CSF

57
Q

Types of Glial Cell Malignancies/Gliomas

A 
Astrocytoma
Brainstem glioma
Ependymoma
Mixed glioma
Oligodendroglioma
Optic nerve glioma
58
Q

Most common type of malignancy

A

Astrocytoma

59
Q

Grading of Astrocytoma

A

Grade I: Pilocytic (2%) (considered benign)
Grade II: Low Grade (8%) (considered benign)
Grade III: Anaplastic (20%)
Grade IV: Glioblastoma multiforme (70%)

60
Q

Most inactive astrocytoma

A

Grade I - Pilocytic

61
Q

If a pilocytic astrocytoma is disregarded it…

A

progresses to a higher grade.

62
Q

Treatment of Pilocytic Astrocytoma

A

Surgical removal

Monitor

Neurology Module (7 decks)

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