Neurology - Brain Tumours

Question 1

How do brain tumours prsent?

Answer 1

May be asymptomatic

Progressive focal neurological symptoms

Raised ICP

Question 2

List the causes of increased pressure in the intracranial space

Answer 2

• Brain tumours
• Intracranial haemorrhage
• Idiopathic intracranial hypertension
• Abscesses or infection

Question 3

What are concerning features of headaches that may indicate intracranial hypertension?

Answer 3

• Constant headache
• Nocturnal
• Worse on waking
• Worse on coughing, straining or bending forward
• Vomiting
• Papilloedema on fundoscopy

Question 4

What are the other presenting features of raised intracranial hypertension?

Answer 4

• Altered mental state
• Visual field defects
• Seizures (particularly partial seizures)
• Unilateral ptosis
• Third and sixth nerve palsies

Question 5

What is papilloedema?

Answer 5

Swelling of the optic disc secondary to raised intracranial pressure

Question 6

What does the term ‘papilloedema’ refer to?

Answer 6

Optic disc swelling due to increased intracranial pressure

Question 7

Why is there papilloedema in raised ICP?

Answer 7

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

Question 8

What are the signs of papilloedema seen on fundoscopy?

Answer 8

• 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

Question 9

What are gliomas?

Answer 9

Tumours of the glial cells in the brain or spinal cord

Question 10

What are glial cells?

Answer 10

Cells that surround and support neurones

e.g. astrocytes, oligodendrocytes and ependymal cells

Question 11

How are gliomas graded?

Answer 11

From 1 (most benign) to 4 (most malignant)

Question 12

List the main types of gliomas from most to least malignant.

Answer 12

• Astrocytoma (most common and aggressive form is glioblastoma)
• Oligodendroglioma
• Ependymoma

Question 13

What are meningiomas?

Answer 13

Tumours growing from the cells of the meninges, usually benign

SOL effect

Question 14

What cancers most often spread to the brain?

Answer 14

• Lung
• Breast
• Renal cell carcinoma
• Melanoma

Question 15

What visual defect can be caused by large pituitary tumours?

Answer 15

Bitemporal hemianopia

Question 16

What hormone deficiencies can pituitary tumours cause?

Answer 16

Hypopituitarism

Question 17

List some conditions caused by excessive hormone release from pituitary tumours.

Answer 17

• Acromegaly
• Hyperprolactinaemia
• Cushing’s disease
• Thyrotoxicosis

Question 18

What are the management options for pituitary tumours?

Answer 18

• Trans-sphenoidal surgery
• Radiotherapy
• Bromocriptine blocks excess prolactin
• Somatostatin analogues blocks GH

Question 19

What are acoustic neuromas?

Answer 19

Benign tumours of the Schwann cells surrounding the auditory nerve

Occur at the cerebellopontine angle

Question 20

What is the typical presentation of acoustic neuromas?

Answer 20

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)

Question 21

What are bilateral acoustic neuromas associated with?

Answer 21

Neurofibromatosis type 2

Question 22

What are the management options for acoustic neuromas?

Answer 22

• Conservative management
• Surgery
• Radiotherapy

Question 23

What is the first-line investigation for suspected brain tumours?

Answer 23

MRI scan

Question 24

How is a definitive histological diagnosis of a brain tumour obtained?

Answer 24

Biopsy during surgery to remove the tumour

Question 25

What are the main management options for brain tumours?

Answer 25

• Surgery
• Chemotherapy
• Radiotherapy
• Palliative care