Neuro-Oncology Flashcards
Frontal Cortex Tumor Presentation (7)
- 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)
Temporal Cortex Tumor Presentation (3)
- Seizure
- Memory disturbance
- Superior quadrantanopia (anopia affecting only a quarter of the visual field)
Parietal Cortex Tumor Presentation (4)
- 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)
Occipital Cortex Tumor Presentation (3)
- Hemianopia
- Visual agnosia (not recognizing things)
- Seizures
Thalamus Tumor Presentation (2)
- Hemianesthesia or sensory disturbances
- Cognitive impairment
Brainstem Tumor Presentation (4)
- Cranial Neuropathies
- Ataxia
- Weakness or sensory disturbances
- Nystagmus
Pineal Region Tumor Presentation (1)
Parinaud syndrome: impairment of upward gaze, dissociation of the pupillary light reflex and the near reflex.
Third Ventricle Tumor Presentation (3)
- Hydrocephalus
- Hypothalamic dysfunction
- Autonomic Dysfunction
Cerebellum Tumor Presentation (4)
- Headache
- Ataxia
- Hydrocephalus
- Dizziness/ Nausea
What is a focal neurological deficit?
Symptoms that come from a focal area.
Do brain tumors usually present with focal deficits?
Depends on the tumor.
If you have a patient with a headache and a focal neurological deficit of short duration, what study do you order?
CT
If you have a patient with a headache and a chronic focal neurologic deficit, what study should you order?
MRI
Papilledema, focal or non-focal?
Non-focal, it is a sign of increased ICP
Hemiparesis, focal or non-focal?
Focal, the tumor is on the opposite side of the paresis. Lesion of the motor cortex
Headache, focal or non-focal?
Non-focal
Hyperreflexia, focal or non-focal?
Non-focal, it is generalized
Unilateral Hyperreflexia, focal or non-focal?
Focal, can be blamed on a lesion
Nausea, focal or non-focal?
Non-focal, but it can be a symptom of a focal lesion
Aphasia, focal or non-focal?
Focal
Astrocytoma (4)
- 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
Glioblastoma Multiforme (3)
- Variegated (different colors) appearance, large, infiltrative, sometimes multifocal
- Untreated, <20% survive one year
- May be calcification changes, with surrounding edema
Oligodendroglioma (4)
- 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
How do you diagnose a glioma tumor?
- Examine the patient first!
- MRI with contrast for:
1. Astrocytoma
2. Gliioblastoma Multiforme
3. Oligodendroglioma
How do you treat a glioma? (4(
- 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
Ependymoma Tumor (3)
- Most common site is the 4th ventricle
- Most common glioma of spinal cord
- Presentation depends on location
What is the diagnosis/treatment/prognosis for ependymoma Tumors? (3)
Diagnosis: CT/MRI
Tx: Surgical + Radiation
Prognosis: survival depends on degree of anaplasia and surgical accessibility, variable!
Metastatic Tumors (3)
- More common than primary tumors
- Hematogenous spread
- Common from the lung, breast, melanoma, GI, thyroid and kidney
Metastatic Tumor Presentation (7)
- S/S: seizures, headache, focal weakness, mental and behavioral derangements, ataxia, aphasia and increased ICP
Metastatic Tumor Diagnosis
- CT with and without contrast
- Multiple nodular deposits
Metastatic Tumor Tx/Prognosis (5)
- Surgery if the tumors are solitary and accessible
- Radiation
- Chemo
- Corticosteroids
- Prognosis: usually poor
Meningioma (4)
- Originates from dura mater or arachnoid
- More common in elderly
- M>F 2:1
- Generally supratentorial, slow growing
Meningioma Prognosis/treatment/diagnosis
- Diagnosis: MRI
- Tx: surgical, then radiation if it is incompletely removed or if there are malignant characteristics
- Prognosis: good
Where are most primary tumors located in adults?
Supratentorial
Where are most primary tumors located in kids?
Brainstem and Cerebellum
Acoustic Neuroma Facts
- “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)
Acoustic Neuroma Presentation (8)
- Unilateral hearing loss
- Other CN deficits like facial pain (CN VII)
- Headache
- Constant dizziness
- Unsteady gait
- Tinnitus
- Facial Weakness
- Disturbance of taste
Acoustic Neuroma PE (5)
- CN exam: V, VII, VIII, XI, XII
- Gait abnormality
- Unilateral ataxia of limbs
- Inequality of reflexes
- Signs of increased ICP (<25%)
Acoustic Neuroma Testing/Diagnosis (4)
- 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
Acoustic Neuroma Tx (4)
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
Pituitary Adenoma (7)
- 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
Pituitary Adenoma Presentation (5)
- 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)
How do you test for prolactin? (4)
- Serum prolactin level
- chlorpromazine test
- TRH provocative test
- L-dopa suppression
Pituitary Adenoma Diagnosis/Testing (2)
- MRI with gadolinium (3mm)
- Plus endocrine testing
Pituitary Adenoma Treatment (4)
- Prolactinomas: bromocriptine
- Acromegaly: ocreotide
- Surgery for those intolerant, or unresponsive tumors
- Incomplete removal is followed by radiation
Craniopharyngioma (3)
- Benign epithelioid tumor
- Compresses optic chiasm
- Once they are bigger than 3cm they are usually cystic and have some calcification
Craniopharyngioma Presentation (3)
- Common in children, can happen in adults
- Increased ICP
- Combined pituitary, hypothalamic, chiasmal derangement
Craniopharyngioma Diagnosis/Testing (2)
- MRI most useful
- If cyst ruptures, can cause aseptic meningitis (decreased glucose in the CSF)
Craniopharyngioma Treatment (7)
- Surgical excision
- Pre/Post op steroids
- Close monitoring, control of temp., water balance
Palliative - Stereotactic aspiration
- Focused radiation
- Ventricular shunting
- Endocrine replacement
Carcinomatous Meningitis (5)
- 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
Leukemia (6)
- Spinal cord tumor
- Leukemic cells found in the CSF
- Treatment includes:
- Radiation
- Intrathecal or IV methotrexate
- Complication: necrotizing leukencephalopathy
Lymphoma (2)
Complication:
- extradural compression of the spinal cord or caudal equina
- results from extension from vertebrae or lymph node of the tumor
Cauda Equina Syndrome (7)
- Saddle anesthesia
- Loss of rectal tone
- loss of bowel/bladder control
- leg weakness
- back pain/leg pain
- sexual dysfunction
- surgical emergency!!!
