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Neurology > Neuro-Oncology > Flashcards

Neuro-Oncology Flashcards

1
Q

Frontal Cortex Tumor Presentation (7)

A
  • Personality changes: disinhibition/irritability
  • Seizures
  • Hemiparesis (weakness one side of body)
  • Urinary urgency and frequency
  • Gait ataxia
  • Aphasia (more pronounced if the tumor is on the left)
  • Gaze preference (deviates away from the lesion)
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2
Q

Temporal Cortex Tumor Presentation (3)

A
  • Seizure
  • Memory disturbance
  • Superior quadrantanopia (anopia affecting only a quarter of the visual field)
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3
Q

Parietal Cortex Tumor Presentation (4)

A
  • Hemianesthesia (anesthesia of one side of the body)
  • Aphasia
  • Neglect (if on the non-dominant side of the brain)
  • Constructional apraxia (cannot put pictures together)
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4
Q

Occipital Cortex Tumor Presentation (3)

A
  • Hemianopia
  • Visual agnosia (not recognizing things)
  • Seizures
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5
Q

Thalamus Tumor Presentation (2)

A
  • Hemianesthesia or sensory disturbances

- Cognitive impairment

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6
Q

Brainstem Tumor Presentation (4)

A
  • Cranial Neuropathies
  • Ataxia
  • Weakness or sensory disturbances
  • Nystagmus
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7
Q

Pineal Region Tumor Presentation (1)

A

Parinaud syndrome: impairment of upward gaze, dissociation of the pupillary light reflex and the near reflex.

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8
Q

Third Ventricle Tumor Presentation (3)

A
  • Hydrocephalus
  • Hypothalamic dysfunction
  • Autonomic Dysfunction
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9
Q

Cerebellum Tumor Presentation (4)

A
  • Headache
  • Ataxia
  • Hydrocephalus
  • Dizziness/ Nausea
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10
Q

What is a focal neurological deficit?

A

Symptoms that come from a focal area.

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11
Q

Do brain tumors usually present with focal deficits?

A

Depends on the tumor.

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12
Q

If you have a patient with a headache and a focal neurological deficit of short duration, what study do you order?

A

CT

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13
Q

If you have a patient with a headache and a chronic focal neurologic deficit, what study should you order?

A

MRI

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14
Q

Papilledema, focal or non-focal?

A

Non-focal, it is a sign of increased ICP

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15
Q

Hemiparesis, focal or non-focal?

A

Focal, the tumor is on the opposite side of the paresis. Lesion of the motor cortex

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16
Q

Headache, focal or non-focal?

A

Non-focal

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17
Q

Hyperreflexia, focal or non-focal?

A

Non-focal, it is generalized

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18
Q

Unilateral Hyperreflexia, focal or non-focal?

A

Focal, can be blamed on a lesion

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19
Q

Nausea, focal or non-focal?

A

Non-focal, but it can be a symptom of a focal lesion

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20
Q

Aphasia, focal or non-focal?

A

Focal

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21
Q

Astrocytoma (4)

A
  • Most common primary brian tumor
  • 4 grades, all good prognosis
  • Better prognosis than glioblastoma multiform
  • The first symptom in two-thirds of patients is a seizure
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22
Q

Glioblastoma Multiforme (3)

A
  • Variegated (different colors) appearance, large, infiltrative, sometimes multifocal
  • Untreated, <20% survive one year
  • May be calcification changes, with surrounding edema
23
Q

Oligodendroglioma (4)

A
  • More benign and slow growing
  • Often calcified or cystic
  • May have a component of astrocytoma
  • Certain genetic varieties have a better response to chemo and a better prognosis
24
Q

How do you diagnose a glioma tumor?

A
  • Examine the patient first!
  • MRI with contrast for:
    1. Astrocytoma
    2. Gliioblastoma Multiforme
    3. Oligodendroglioma
25
Q

How do you treat a glioma? (4(

A
  • Usually surgical followed by radiation
  • Surgical de-bulking prolongs survival (just taking out some of the tumor)
  • Corticosteroids before/after
  • Anticonvulsants if seizures are present
26
Q

Ependymoma Tumor (3)

A
  • Most common site is the 4th ventricle
  • Most common glioma of spinal cord
  • Presentation depends on location
27
Q

What is the diagnosis/treatment/prognosis for ependymoma Tumors? (3)

A

Diagnosis: CT/MRI
Tx: Surgical + Radiation
Prognosis: survival depends on degree of anaplasia and surgical accessibility, variable!

28
Q

Metastatic Tumors (3)

A
  • More common than primary tumors
  • Hematogenous spread
  • Common from the lung, breast, melanoma, GI, thyroid and kidney
29
Q

Metastatic Tumor Presentation (7)

A
  • S/S: seizures, headache, focal weakness, mental and behavioral derangements, ataxia, aphasia and increased ICP
30
Q

Metastatic Tumor Diagnosis

A
  • CT with and without contrast

- Multiple nodular deposits

31
Q

Metastatic Tumor Tx/Prognosis (5)

A
  • Surgery if the tumors are solitary and accessible
  • Radiation
  • Chemo
  • Corticosteroids
  • Prognosis: usually poor
32
Q

Meningioma (4)

A
  • Originates from dura mater or arachnoid
  • More common in elderly
  • M>F 2:1
  • Generally supratentorial, slow growing
33
Q

Meningioma Prognosis/treatment/diagnosis

A
  • Diagnosis: MRI
  • Tx: surgical, then radiation if it is incompletely removed or if there are malignant characteristics
  • Prognosis: good
34
Q

Where are most primary tumors located in adults?

A

Supratentorial

35
Q

Where are most primary tumors located in kids?

A

Brainstem and Cerebellum

36
Q

Acoustic Neuroma Facts

A
  • “Vestibular Schwannoma” typically affects the vestibular branch of the CN VIII
  • Can occur as part of von recklinghausen neurofibromatosis genetic disorder where tumors grow on nerves)
37
Q

Acoustic Neuroma Presentation (8)

A
  • Unilateral hearing loss
  • Other CN deficits like facial pain (CN VII)
  • Headache
  • Constant dizziness
  • Unsteady gait
  • Tinnitus
  • Facial Weakness
  • Disturbance of taste
38
Q

Acoustic Neuroma PE (5)

A
  • CN exam: V, VII, VIII, XI, XII
  • Gait abnormality
  • Unilateral ataxia of limbs
  • Inequality of reflexes
  • Signs of increased ICP (<25%)
39
Q

Acoustic Neuroma Testing/Diagnosis (4)

A
  • CT with contrast will pick up tumors >2cm
  • MRI with gadolinium contrast will pick up smaller tumors
  • Audiology and vestibular testing
  • CSF protein is elevated in 2/3rd of pts, even if they are silent lesions
40
Q

Acoustic Neuroma Tx (4)

A

Surgical Excision
- Hearing can be preserved in 1/3rd of pts with tumors smaller than 2.5cm
- Intraoperative monitoring of brainstem auditory responses and facial nerve EMG
Focused radiation/Gamma Knife
-preferred for older patients and with reoccurrence
- better preservation

41
Q

Pituitary Adenoma (7)

A
  • Effect visual fields before endocrine
  • Age linked
  • Many are prolactin secreting adenomas
  • 10-15% secrete ACTH
  • 33% are non-functioning (doesn’t affect pituitary)
  • Very rare to have them secrete TSH or gonadotropins
  • Can affect one or many hormones
42
Q

Pituitary Adenoma Presentation (5)

A
  • Complete/partial bitemporal hemianopia
  • May extend to cavernous sinus and develop ocular motor palsies
  • Females: amenorrhea-galactorrhea syndrome (produce breast milk)
  • Acromegaly (broad shoulders, large jaw etc.)
  • Cushings disease (ACTH, endogenous)
43
Q

How do you test for prolactin? (4)

A
  • Serum prolactin level
  • chlorpromazine test
  • TRH provocative test
  • L-dopa suppression
44
Q

Pituitary Adenoma Diagnosis/Testing (2)

A
  • MRI with gadolinium (3mm)

- Plus endocrine testing

45
Q

Pituitary Adenoma Treatment (4)

A
  • Prolactinomas: bromocriptine
  • Acromegaly: ocreotide
  • Surgery for those intolerant, or unresponsive tumors
  • Incomplete removal is followed by radiation
46
Q

Craniopharyngioma (3)

A
  • Benign epithelioid tumor
  • Compresses optic chiasm
  • Once they are bigger than 3cm they are usually cystic and have some calcification
47
Q

Craniopharyngioma Presentation (3)

A
  • Common in children, can happen in adults
  • Increased ICP
  • Combined pituitary, hypothalamic, chiasmal derangement
48
Q

Craniopharyngioma Diagnosis/Testing (2)

A
  • MRI most useful

- If cyst ruptures, can cause aseptic meningitis (decreased glucose in the CSF)

49
Q

Craniopharyngioma Treatment (7)

A
  • Surgical excision
  • Pre/Post op steroids
  • Close monitoring, control of temp., water balance
    Palliative
  • Stereotactic aspiration
  • Focused radiation
  • Ventricular shunting
  • Endocrine replacement
50
Q

Carcinomatous Meningitis (5)

A
  • Spinal cord tumor
  • Widespread dissemination of tumor cells in CSF
  • Diagnose by CSF, may have to repeat LPs to get copious CFS
  • Rare, very bloody CSF
  • Poor prognosis
51
Q

Leukemia (6)

A
  • Spinal cord tumor
  • Leukemic cells found in the CSF
  • Treatment includes:
  • Radiation
  • Intrathecal or IV methotrexate
  • Complication: necrotizing leukencephalopathy
52
Q

Lymphoma (2)

A

Complication:

  • extradural compression of the spinal cord or caudal equina
  • results from extension from vertebrae or lymph node of the tumor
53
Q

Cauda Equina Syndrome (7)

A
  • Saddle anesthesia
  • Loss of rectal tone
  • loss of bowel/bladder control
  • leg weakness
  • back pain/leg pain
  • sexual dysfunction
  • surgical emergency!!!

Neurology (12 decks)

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