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Neurology > Neurology: Clinical - Brain tumours > Flashcards

Neurology: Clinical - Brain tumours Flashcards

1
Q

What are the two categories of brain tumour?

A

Primary and secondary

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2
Q

What are the different types of primary brain tumour?

A

Neuroepithelial tissue = glioma
Meninges = meningioma
Pituitary = adenoma

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3
Q

What are the commonest types of secondary brain tumour?

A 
Renal cell carcinoma
Lung carcinoma
Breast carcinoma
Malignant melanoma
GI tract
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4
Q

What is the more common brain tumour: primary or secondary?

A

Secondary e.g. metastasis

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5
Q

What are gliomas derived from?

A

Astrocytes

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6
Q

A 66yo, left handed, woman presents with ataxia and incoordination. Where would you expect her lesion to be?

A

Cerebellum

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7
Q

A 44yo, right handed, woman presents with acalculia, agraphia, finger agnosia and right/left confusion. Where would you expect her lesion to be?

A

Left parietal lobe

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8
Q

A 30yr, right handed, man presents with a bitemporal hemianopia. Where would you suspect his lesion to be?

A

Pituitary

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9
Q

50yr, right handed man, presented with congnitive language dysfunction (difficulty reading, difficulty expressing what he wished to say, short-term memory impairment), 6 wk history of posterior rib pain. PMHx included left nephrectomy for renal cell carcinoma 5 years previously. Where do you think the lesion is?

A

Left temporo-parietal area

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10
Q

Where would a lesion only be if you were have epilepsy due to a tumour?

A

Only in lesions above the tentorium

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11
Q

What are the investigations for a suspected brain tumour?

A 
CT
MRI
PET
Angiography
Is suspected mets: CT chest/abdo/pelvis, mammography, biopsy skin lesions/lymph nodes
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12
Q

What do you NOT do if there are signs and symptoms to suggest an intracranial mass lesion?

A

Do NOT perform an LP

Straight to CT or MRI

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13
Q

Why not do an LP if there are signs and symptoms to suggest an intracranial mass lesion?

A

Increased ICP could mean LP would cause brain herniation and death, this is because of a sudden decrease in pressure due to removal of CSF

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14
Q

In neurology, what is the drug mannitol used for?

A

Reduce swelling and pressure inside the eye or around the brain

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15
Q

What are some causes of raised intracranial pressure?

A

Localised lesions e.g. haemorrhage, tumour, abscess

Generalised pathology e.g. oedema post trauma

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16
Q

What are localised lesions in the head often called?

A

Space Occupying Lesions in head (SOL)

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17
Q

What is effect of intracranial SOL?

A

Amount of tissue increases = raises ICP = causes internal shift (herniation) between the intracranial spaces

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18
Q

What is it called when the cerebrum moves inferiorly over the edge of the tentorium?

A

Uncal herniation

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19
Q

What is it called when the cerebellum moves inferiorly into the foramen magnum?

A

Coning

20
Q

What is it called when the brain herniates underneath the falx cerebri?

A

Subfalcine herniation

21
Q

What else is affected as a result of subfalcine herniation?

A

Lateral ventricle is crushed flat and displaced downwards

22
Q

What else is affected as a result of uncal herniation?

A

Cerebral aqueduct crushed and narrowed

23
Q

What can happen as a result of cerebellar tonsillar herniation?

A

Brain stem death

24
Q

How can brain tumours can localised ischaemia?

A

Swelling and shift -> squeeze nearby tissue

25
Q

What are the symptoms if tumours squeeze on cortex and brainstem?

A

Morning headaches and sickness

26
Q

What is the different diagnoses of morning headaches?

A

Hypoglycaemic attack when asleep

Space occupying lesion (SOL)

27
Q

What are the symptoms if the tumours squeeze on the optic nerve?

A

Papilloedema

28
Q

As pressure increases in the brain, what are the signs?

A

Pupillary dilation - squeeze on CNIII
Falling GCS - squeeze on cortex and brainstem
Brain stem death - coning of brain

29
Q

What are adult malignant tumours?

A

Gliomas

30
Q

What are childhood malignant tumours?

A

Medulloblastomas

31
Q

Where are the majority of adult CNS tumours?

A

Above the tentorium

32
Q

Where are the majority of child CNS tumours?

A

Below the tentorium

33
Q

Do gliomas metastasise?

A

No - gliomas do NOT metastasise outside the CNS

34
Q

What are examples of gliomas?

A

Astrocytoma (glioblastoma)
Oligodendroglioma
Ependymoma

35
Q

What do astrocytes do?

A

Have long processes which support other cells structurally and biochemically

36
Q

What are two types of astrocytoma?

A

Low grade astrocytoma

Glioblastoma

37
Q

What is more malignant: astrocytoma or glioblastoma?

A

Glioblastoma

38
Q

What are the characteristics of glioblastoma?

A

Cellular, atypical tumour, with necrosis under microscope

Grow quickly, often present as large tumours

39
Q

What is a medulloblastoma a tumour of?

A

Primitive neucroectoderm (primitive neural cells)

40
Q

What is meningioma a tumour of?

A

Arachnocytes - cells that make up the meninges

41
Q

Are meningiomas slow or fast growing?

A

Slow growing

42
Q

What is an CNVIII schwannoma often called?

A

Acoustic neuroma

43
Q

How does an acoustic neuroma usually present?

A

Unilateral deafness

44
Q

Where is an acoustic neuroma usually found?

A

At angle between pons and cerebellum

45
Q

Is a pituitary adenoma benign or malignant?

A

Benign

46
Q

How does a pituitary adenoma grow?

A

Superiorly

47
Q

What is a tumour of blood vessels in the brain called?

A

Haemangioblastoma

Neurology (9 decks)

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