Neurology: Clinical - Brain tumours

Question 1

What are the two categories of brain tumour?

Answer 1

Primary and secondary

Question 2

What are the different types of primary brain tumour?

Answer 2

Neuroepithelial tissue = glioma
Meninges = meningioma
Pituitary = adenoma

Question 3

What are the commonest types of secondary brain tumour?

Answer 3

Renal cell carcinoma
Lung carcinoma
Breast carcinoma
Malignant melanoma
GI tract

Question 4

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

Answer 4

Secondary e.g. metastasis

Question 5

What are gliomas derived from?

Answer 5

Astrocytes

Question 6

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

Answer 6

Cerebellum

Question 7

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

Answer 7

Left parietal lobe

Question 8

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

Answer 8

Pituitary

Question 9

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?

Answer 9

Left temporo-parietal area

Question 10

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

Answer 10

Only in lesions above the tentorium

Question 11

What are the investigations for a suspected brain tumour?

Answer 11

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

Question 12

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

Answer 12

Do NOT perform an LP

Straight to CT or MRI

Question 13

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

Answer 13

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

Question 14

In neurology, what is the drug mannitol used for?

Answer 14

Reduce swelling and pressure inside the eye or around the brain

Question 15

What are some causes of raised intracranial pressure?

Answer 15

Localised lesions e.g. haemorrhage, tumour, abscess

Generalised pathology e.g. oedema post trauma

Question 16

What are localised lesions in the head often called?

Answer 16

Space Occupying Lesions in head (SOL)

Question 17

What is effect of intracranial SOL?

Answer 17

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

Question 18

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

Answer 18

Uncal herniation

Question 19

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

Answer 19

Coning

Question 20

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

Answer 20

Subfalcine herniation

Question 21

What else is affected as a result of subfalcine herniation?

Answer 21

Lateral ventricle is crushed flat and displaced downwards

Question 22

What else is affected as a result of uncal herniation?

Answer 22

Cerebral aqueduct crushed and narrowed

Question 23

What can happen as a result of cerebellar tonsillar herniation?

Answer 23

Brain stem death

Question 24

How can brain tumours can localised ischaemia?

Answer 24

Swelling and shift -> squeeze nearby tissue

Question 25

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

Answer 25

Morning headaches and sickness

Question 26

What is the different diagnoses of morning headaches?

Answer 26

Hypoglycaemic attack when asleep | Space occupying lesion (SOL)

Question 27

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

Answer 27

Papilloedema

Question 28

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

Answer 28

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

Question 29

What are adult malignant tumours?

Answer 29

Gliomas

Question 30

What are childhood malignant tumours?

Answer 30

Medulloblastomas

Question 31

Where are the majority of adult CNS tumours?

Answer 31

Above the tentorium

Question 32

Where are the majority of child CNS tumours?

Answer 32

Below the tentorium

Question 33

Do gliomas metastasise?

Answer 33

No - gliomas do NOT metastasise outside the CNS

Question 34

What are examples of gliomas?

Answer 34

Astrocytoma (glioblastoma) Oligodendroglioma Ependymoma

Question 35

What do astrocytes do?

Answer 35

Have long processes which support other cells structurally and biochemically

Question 36

What are two types of astrocytoma?

Answer 36

Low grade astrocytoma | Glioblastoma

Question 37

What is more malignant: astrocytoma or glioblastoma?

Answer 37

Glioblastoma

Question 38

What are the characteristics of glioblastoma?

Answer 38

Cellular, atypical tumour, with necrosis under microscope | Grow quickly, often present as large tumours

Question 39

What is a medulloblastoma a tumour of?

Answer 39

Primitive neucroectoderm (primitive neural cells)

Question 40

What is meningioma a tumour of?

Answer 40

Arachnocytes - cells that make up the meninges

Question 41

Are meningiomas slow or fast growing?

Answer 41

Slow growing

Question 42

What is an CNVIII schwannoma often called?

Answer 42

Acoustic neuroma

Question 43

How does an acoustic neuroma usually present?

Answer 43

Unilateral deafness

Question 44

Where is an acoustic neuroma usually found?

Answer 44

At angle between pons and cerebellum

Question 45

Is a pituitary adenoma benign or malignant?

Answer 45

Benign

Question 46

How does a pituitary adenoma grow?

Answer 46

Superiorly

Question 47

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

Answer 47

Haemangioblastoma