Neurological tumours

Question 1

• The most common childhood brain tumour.
• Well circumscribed
• Most often in posterior fossa

Answer 1

Pilocytic astrocytoma

Question 2

The most common malignant childhood brain tumour

Answer 2

Medulloblastoma

Question 3

Medulloblastoma most commonly affects the ______ and can cause compression of ______

Answer 3

Cerebellum
4th ventricle (causing hydrocephalis)

Can also cause truncal ataxia (cebrellar vermis) + drop mets to the spinal cord

Question 4

Ependymoma most commonly affects ______ and causes ______

Answer 4

4th ventricle
Hydrocephalus

Question 5

________ is the most common chilhood supratentorial tumour

Answer 5

Craniopharyngioma

Question 6

What childhood tumour is associated with calcification, bitemporal hemianopia + high recurrence rate

Answer 6

Craniopharyngioma

Question 7

Perinaud syndrome describes what features in _______ tumours?

Answer 7

In pineal tumours:
- Upward/ vertical gaze palsy
- convergence-retraction nystagmus
- light-near dissociation
- Ataxia

Question 8

__________ is the most common, malignant brain tumour in adults

Answer 8

Glioblastoma (grade IV astrocytoma)

Question 9

Glioblastoma gross anatomical features

Answer 9

Can cross corpus callosum

In cerebral hemispheres

Question 10

• Often affects the frontal lobes
• Rare, slow growing
• Calcified

Answer 10

Oligodendrocytes

Question 11

• Females > Males
• Extra-axial tumour
• Can present with seizure/ focal neurology

Answer 11

Meningioma

Question 12

Most common cerebellar in adults

Associated with von Hippel-Lindau syndrome

Answer 12

Hemangioblastoma

Question 13

What brain tumour can cause secondary polycythema secondary to EPO production

Answer 13

Hemangioblastoma

Question 14

Associated with neurofibrosis type 2 when bilateral

Answer 14

Schwannomas

Question 15

Schwannomas commonly affect what nerves

Answer 15

Cranial nerve 5, 7, 8
Peripheral nerves

Question 16

Can present with hearing loss and tinnitus

Often localised to the internal acoustic meatus

Answer 16

Schwannoma

Question 17

First line treatment for prolactinoma

Answer 17

Dopamine agonist
- Cabergoline
- Bromocroptine

Question 18

Disconnection hyperprolactinoma

Answer 18

Infundobulat stalk damage
- inhibits hypothalamic dopamine effect on pituitary lactotrophs (i.e. tumour with suprasellar extension, trauma, surgery)

Management- surgery

Question 19

Treatment of acoustic neuromas

Answer 19

Significant hearing loss/ large tumour- surgical resection/ radiation

Small tumour/ minimal hearing loss/ very old age- MRI surveillance 6-12 months

Question 20

Treatment of acromegaly

Answer 20

1st line- surgery
- Transsphenoidal adenomectomy
- parasellar/ inoperable disease= surgical debulking

Inoperable/ unsuccessful tumour- medication/ radiotherapy
- somatostatin analogues- ocreotide, lanreotide
- dopamine agonist
- GH receptor antagonist= pegvisomant

Question 21

Follow up after treatment of acromegaly

Answer 21

IGF-1 and GH levels 12 weeks post-surgery, then annnually

Annual hormone testing for hypopituitrism

MRI 12-weeks post-surgery

Question 22

Complications of acromeagly

Answer 22

CVD- main cause of death
- HTN, LVH, cardiomyopathy

Diabetes

Colon polyps/ cancer

Thyroid cancer/ enlargement

Carpal tunnel

Cerebral aneurysm

Hypopituitarism