Neurological Neoplasms Lecture Powerpoint Flashcards
Primary vs secondary CNS tumors
Primary originate in the tissue of the brain (meninges, glial cells, nerve sheath, etc) vs secondary which is due to metastasis
The most common type of primary CNS tumor in children and 2 most common in adults
Glioma, glioma and meningiomas
Most CNS tumors in adults are…
….metastatic in origin
In adults most CNS tumors are ___ while in children they are ____
Supratentorial, infratentorial
Risk factors for CNS tumor development (3)
- Ionizing radiation exposure
- genetics
- trauma or infection
Classic presentation raising concern for a CNS tumor (4)
- Seizure
- focal neuro deficits
- cognitive dysfunction
- increased ICP
Classic triad of increased intracranial pressure
Headache, nausea, papilledema
Rapidly growing tumors cause ___ while slow growing tend to cause ___
headaches, seizures
Headache caused by brain tumor accounts for __% of headaches in the general population, how is it typically prescribed?
1%, nonpulsatile bandlike pain around the head (tension type) almost always with other deficits
Red flags for headache and CNS lesions that require neuroimaging (6)
- Acute severe headache onset after 50
- headache changed form previous pattern
- headache on exertion, onset at night or early morning, progressive in nature
- new neurologic signs accompanying
- associated with illness
- precipitation with valsalva
Imaging study of choice for concern of headache being related to CNS lesion and one alternative
- MRI with contrast
- CT with contrast
If a tumor is found on CNS then next step is to…
….screen for systemic malignancy via CT of chest/abdomen/pelvis and then refer to neurosurgery. Metastases may not need biopsy if known primary source
3 fundamental treatments for CNS tumors
- surgical resection
- radiotherapy or chemotherapy
- shunting for hydrocephalus
Noninvasive symptom treatment for CNS tumor (5)
- glucocorticoids (high dose dexamethasone for severe symptoms unless suspicion for lymphoma)
- analgesics
- Anticonvulsants
- VTE prophylaxis if immobilized (heparin)
- palliative care
Astrocytoma
Most common intracranial glioma part of brain itself linked to ionizing radiation and rare genetic syndromes, good prognosis if resected
Glioblastoma
Very aggressive type of glioma with necrotic center that has median survival rate of 12-15 months and a high recurrence rate
Meningioma
Most common primary brain tumor, often slow growing and some are benign, treated with large surgical resection otherwise radiation and or chemo, sometimes if small watchful waiting
Oligodendroma
A type of glioma that is more responsive and has a better prognosis compared to a astrocytoma, treatment is surgical resection and radiation with a median survival >10 years
Schwannoma
A nerve sheath tumor that is progressive unilateral hearing loss affecting the vestibule, treated with surgical resection
Ependymoma
A type of glioma usually in the spinal canal and curable with surgical resection
Medulloblastoma
A embryonal malignant, most common tumor in children that 70% survive but have cognitive impairment, treated by surgical resection, radiation, and chemo
CNS Lymphoma
A B cell malignancy that usually occurs in the immunosuppressed and may be a single mass, multiple masses, or meningeal, requires testing for HIV and a PET scan, treated by radiation, chemo, methotrexate
Pituitary adenoma
CNS tumor originating from hormone producing cells in pituitary, nearly all are benign but depending on cell type cause different conditions (prolactinoma, acromegaly, and cushing’s disease), treatment is pharmacologic with surgery if needed
Most common metastatic lesions to CNS (5)
- lung
- breast
- melanoma
- renal
- GI
