Neurology - Brain Tumours Flashcards
How do brain tumours prsent?
May be asymptomatic
Progressive focal neurological symptoms
Raised ICP
List the causes of increased pressure in the intracranial space
- Brain tumours
- Intracranial haemorrhage
- Idiopathic intracranial hypertension
- Abscesses or infection
What are concerning features of headaches that may indicate intracranial hypertension?
- Constant headache
- Nocturnal
- Worse on waking
- Worse on coughing, straining or bending forward
- Vomiting
- Papilloedema on fundoscopy
What are the other presenting features of raised intracranial hypertension?
- Altered mental state
- Visual field defects
- Seizures (particularly partial seizures)
- Unilateral ptosis
- Third and sixth nerve palsies
What is papilloedema?
Swelling of the optic disc secondary to raised intracranial pressure
What does the term ‘papilloedema’ refer to?
Optic disc swelling due to increased intracranial pressure
Why is there papilloedema in raised ICP?
Optic nerve is a continuation of the forebrain as such the otpic nerve is surrounded by the meninges
Raised CSF pressure flows into optic nerve sheath increasing pressure around optic nerve and behind the optic disc
What are the signs of papilloedema seen on fundoscopy?
- Blurring of the optic disc margin
- Elevated optic disc
- Loss of venous pulsation
- Engorged retinal veins
- Haemorrhages around the optic disc
- Paton’s lines- creases or folds in retina around the optic disc
What are gliomas?
Tumours of the glial cells in the brain or spinal cord
What are glial cells?
Cells that surround and support neurones
e.g. astrocytes, oligodendrocytes and ependymal cells
How are gliomas graded?
From 1 (most benign) to 4 (most malignant)
List the main types of gliomas from most to least malignant.
- Astrocytoma (most common and aggressive form is glioblastoma)
- Oligodendroglioma
- Ependymoma
What are meningiomas?
Tumours growing from the cells of the meninges, usually benign
SOL effect
What cancers most often spread to the brain?
- Lung
- Breast
- Renal cell carcinoma
- Melanoma
What visual defect can be caused by large pituitary tumours?
Bitemporal hemianopia
What hormone deficiencies can pituitary tumours cause?
Hypopituitarism
List some conditions caused by excessive hormone release from pituitary tumours.
- Acromegaly
- Hyperprolactinaemia
- Cushing’s disease
- Thyrotoxicosis
What are the management options for pituitary tumours?
- Trans-sphenoidal surgery
- Radiotherapy
- Bromocriptine blocks excess prolactin
- Somatostatin analogues blocks GH
What are acoustic neuromas?
Benign tumours of the Schwann cells surrounding the auditory nerve
Occur at the cerebellopontine angle
What is the typical presentation of acoustic neuromas?
40-60 year old presenting with gradual onset of
* Unilateral sensorineural hearing loss
* Unilateral tinnitus
* Dizziness or imbalance
* Sensation of fullness in the ear
* Facial nerve palsy (if large)
What are bilateral acoustic neuromas associated with?
Neurofibromatosis type 2
What are the management options for acoustic neuromas?
- Conservative management
- Surgery
- Radiotherapy
What is the first-line investigation for suspected brain tumours?
MRI scan
How is a definitive histological diagnosis of a brain tumour obtained?
Biopsy during surgery to remove the tumour
