Neuro: SOL Flashcards
Clinical presentations of SOL?
Seizures
Focal neurology and gait disturbance
Raised intracranial pressure:
- Headaches
- Vomiting
- Papilodema
Neuropsychiatry effects
-Personality
- Mental state
- Memory and cognition
Endocrine abnormalities (pituitary)
Inicidental finding on imaging (e.g. minor head injury)
What invetigations to order when ?SOL?
CT +/- contrast
MRI (usually with contrast) - specilist units: MR sprectoscopy (to assess metabolism), MR perfusion (vascularity)
Diffusion weighted MRI
How is contrast useful in a CT head when looking for a SOL?
Areas of vascularity are more prominent, helpful if tumour or infection is suspected
What eGFR is insufficient for CT contrast?
Below 30
How to describe an MRI/CT?
Particularly Patient imaging technique details
Interesting Intra or extra exial
Surgeons Shape
Love Location (supra or inferiorlateral, lobes or parts of the brain involved)
Carefully Contrast enhancement (homogenous/hetrogenous, rim enhancement)
Drilling Density hypo/hyper (or intensity in MRI)
Massive Mass effects (effacement of sulci:ipsilateral/contralateral, midline shift, ventricle compression, basal cisterns: obliterated/patient)
Burr Border - how definied, oedema
Holes Hydrocephalus
Extra-axial SOL?
Pineal and pituitary lesions
Differential diagnosis for intracranial mass lesions?
Vascular - haemorrhage, infarct, vascular malformation, aneurysm
Infection - abcess
Neoplastic - metastasis, primary brain tumours
Cyst
Inflammatory - MS, granulomatous disease
Most common primary intracranial tumours in adults?
Benign: Meningioma
Mallignant: Gilioblastoma Multiforme (GBM)
Most common primary intracranial tumours in children?
Benign: Astrocytoma/Gliomas (Pilocytic astrocytoma, brainstem giloma, ependymoma)
Mallignant: Ependymoma, Medulloblastoma
Grading of CNS tumours
Grade I: Slow growing, relatively contained with well defined edges
Grade II: Slow, relatively contained with well definied edges
Grade III: Fast aggressive, mallignant
Grade IV: Fast, aggressive, mallignant
What is an Astrocytoma (Giloma) and what are its features?
Most common CNS tumour in children.
Arises from astrocytes
Mostly low grade
Develop anywhere in the CNS
Association with neurofibromatosis 1
Chuldren ages 5-8
M=F
Presentation: Non specific, morning headaches, N&V, double vision, seizures (fits)
What is a medulloblastoma and how does it present?
2nd most common childhood CNS tumour
Grade IV
Arise from neuroectoderm tissue
Majority arise in cerebellum, may cause compression of 4th ventricle, resulting in hydrocephalus.
Affects children aged 3-4 years, & 8-10 years
M>F
Can seed into spinal cord causing paraplegia
Presentation: non-specific, cerebellar dysfunction - poor co-oridnation, difficulty walking and clumsiness (ataxia), loss of appetite, behaviour changes (decreased social interaction, irritable/unsettled), mass effect
What is mass effect?
In a SOL when surrounding areas of the brain become compressedas a result and as a result of the lesion which manefests as focal neurology
Giloblastoma Multiforme vs Meningioma
Both: Common primary adult brain tumours.
Presentation: Headaches (worse in morning), seizures (fits), nausea and vomiting, cognitive or personality changes, focal weakness (arm or leg), loss of eyesight, hearing loss
GBM: High grade only (IV), a type of astrocytoma, affects over 65s
Meningioma: Mostly low grade (benign), arises from the dura mater of meninges, snowball effect on imaging, more comman in women
What is an oligodendroglioma and how does it present?
Variable (Grade I-Grade III)
Commonly located in cerebral hemisphere (frontal lobe)
Accounts for 2-5%
Arises from oligodendrocytes (giloma), affects 40-50 years
Presentation:
Headaches (worse in morning), seizures (fits), nausea and vomiting, cognitive or personality change, focal weakness (arm or leg), loss of eyesight, hearing loss)
What is Primary CNS lymphoma (PCNSL) and how does it present?
Mostly high-grade
Associated with immunocompromised individuals
M>F
Arise from dura mater of meninges
Affects>50 years
90% arise from B cells
Presentation:
Headaches (worse in morning), seizures (fits), nausea and vomiting, cognitive or personality change, focal weakness (arm or leg), loss of eyesight, hearing loss
Piocytic astrocytoma (Giloma) histological hallmarks?
Rosenthal fibers, eosinophillic fibres with corckscrew-like configuration
GFAP
Medulloblastoma histopathological hallmarks
Small round blue cells
Homer Wright rosettes
Giloblastoma Multiforme (GBM) histopathological hallmarks
Pleomorphic anaplastic cells that form pseudopalisades due to central necrosis or haemorrhage
Microvascular proliferation
GFAP positive
Menigioma histopathological hallmarks
Spindle cells arranged in whorls
Psammoma bodies
Oligodendroglioma histopathological hallmarks
Large caculoated cells with round nuclei (fried egg cells)
Chicken wire pattern of capillary anastomoses
Primary CNS lymphoma histopathological hallmarks
Diffuse large B cell lymphoma
Dense cellular aggregates of atypical lymphoid cells with dense perivascular aggregates
Anatomical differentiation of primary tumours
Tentorium cerebelli (extension of dura matter) seperates the crainial cavity inro supratentorial and infratentorial compartments
Supratentorial structures: cerebrum, third ventricle, lateral ventricle, chroid plexus, pineal gland, hypothalamus and pituitary gland
Generally adult forms
Infratentorial structues (located in the posterior fossa): cerebellum, fourth ventricle and brainstem (midbrain, pons and medulla)
Generally child forms