Neuro Oncology Flashcards
Spatial impairment / “getting lost in a familiar area” suggests . . .
. . . parietal involvement
Brain tumor headache
Usually dull, intermittent, non-throbbing, frontal
May mimic tension-type OR migraine type
Classically “worse in the morning” and progressive
“Hiccups” may indicate . . .
. . . phrenic nerve irritation
Non-contrast CT in brain tumors
~90% sensitive
Suprisingly helpful
Magic Dr for Ring enhancing lesions on MRI
- Metastasis
- Abscess
- Glioma
- Infarct (Resolving)
- Contusion (resolving hematoma)
- Demyelinating disease (tumefactive MS, because it looks like a tumor)
- Radiation necrosis
Brain abscesses on MRI
Central restricted diffusion
Basically all the pus is what enhances
“Multiple ring enhaning lesions”
Toxo should be high on the differential
Smooth and thin borders of a ring enhancing lesion
abscess
When to steroids and when not to steroids in brain tumors
- Dexamethasone is the preferred steroid
- We avoid in possible lymphoma or in immunocompromised patients
- But, for most other solid brain tumors, they are indicated
Surgery in brain cancer
Surgery virtually never cures adult glioma
Biopsy is usually the indication for surgery in the setting of brain tumor
A meningioma often has a ___, which can be seen on imaging
A meningioma often has a dural tail, which can be seen on imaging
“CSF cleft”
Thin ribbon of CSF that can be seen around a meningioma, indicating that it is NOT attached to the brain parenchyma
Risk factors for meningioma
NF2
Radiation exposure
CNS lymphoma has a ___ distribution on MRI
CNS lymphoma has a paintbrush splatter distribution on MRI
When patients are immunocompromised, CNS lymphoma looks. . .
. . . ring-enhancing, rather than blotchy otherwise
It looks a lot more like an abscess.
Induction and maintenance therapy for brain tumors
Induction: Methotrexate or rituximab + methotrexate
Complications of treatment for brain tumors
Radiation and methotrexate can both cause leukoencephalopathy as a complication
Foster-Kennedy syndrome
A clinical syndrome of ipsilateral atrophy of the optic nerve (due to nerve compression), contralateral papilledema (due to elevated ICP), and anosmia.
Usually caused by frontal lobe tumors, most commonly meningiomas.
In women, prolactinomas often present with ___.
In men, prolactinomas often present with ___.
In women, prolactinomas often present with galactorrhea.
In men, prolactinomas often present with erectile dysfunction, gynecomastia, and loss of axillary hair.
“Thyrotropic” pituitary adenoma
Caused by secondary hyperthyroidism (TSHoma)
Primary hypothyroidism with secondarily increased TSH does not technically count under this diagnosis.
Can aripiprazole cause hyperprolactinemia?
NO!
Because it is special among the dopamine blockers.
. Aripiprazole acts as an agonist under hypodopaminergic conditions (thereby preventing hyperprolactinemia) but antagonizes D2 receptors under hyperdopaminergic conditions (thus retaining its antipsychotic effect).
Typical locations of various brain tumors
Most common cause of acquired hypopituitarism in children
Craniopharyngioma
What is going on in this image?
Medulloblastoma
Note the solid and cystic components (cystic is the inferior-most) and the location
Commonly in kids. They present with truncal ataxia, generalized cerebellar abnormalities, and double vision/oculomotor abnormalities
“Multiple round lesions at the gray-white junction”
In other words, “metastatic malignancy”
What is going on in this image?
A pilocytic astrocytoma
It is the most common brain tumor found in children and is usually located within the posterior fossa
Most common pinealoma in children
A germinoma, which secretes β-hCG
Increased β-hCG stimulates the Leydig cells of the testes to produce excessive testosterone, which causes precocious puberty in boys
Parinaud syndrome
- Syndrome of four ocular anomalies:
- Vertical gaze palsy with nystagmus on upward gaze
- Argyll Robertson pupils
- Light-near dissociations
- Unilateral/Bilateral lid retraction (Collier’s sign)
- These symptoms are due to compression of the superior/inferior colliculi and Edinger-Westphal nuclei
- May be caused by: pinealoma, MS, hydrocephalus, stroke
A medulloblastoma classically presents in __ in a young child.
An ependymoma classically presents in __ in a young child.
A medulloblastoma classically presents in the cerebellar vermis in a young child.
An ependymoma classically presents in the fourth ventricle in a young child.
“Headache that is worse in the morning” + “Babinski sign” = ___
“Headache that is worse in the morning” + “Babinski sign” = Frontal lobe tumor
Options for treatment in metastatic brain cancer
- Steroids to reduce intracranial edema
- If there is a single brain lesion (oligometastatic disease), surgery or whole brain radiation (preferably gamma knife) improves survival
- Stereotactic radiation is used in tumors that are surgically inaccessible
Favorable prognostic factors in metastatic brain cancer
- Age < 60
- Two or less brain mets
- Good baseline function
- Successful surgical resection
Two most common cancers to metastasize to the brain, in order
- Lung cancer
- Breast cancer
