Neurology Neoplasms

Question 1

Astrocytoma

Answer 1

• Most common PRIMARY childhood CNS tumors that develop from astrocytes
• often Benign
• Definition:
  
  • tumors arising from astrocytes (star-shaped glial cells of the brain & spinal cord)
  • Most common type of glioma
  • Grades 1I-IV
    
    • grade four = glioblastoma = most common primary malignant brain tumor & has poor prognosis
• Location:
  
  • can occur anywhere in the brain or spinal cord; cerebrum most common in adults; brain stem, cerebrum, & cerebellum most common in children
• Types:
  
  • Anaplastic astrocytoma (Gr III)
  • -Glioblastoma multiforme (Gr IV): most malignant glioma, middle aged adults, frontal/temporal lobes most common location
• S.sxs:
  
  • HAs
  • -Focal deficits: depends on lesion location
  • -Cognitive dysfunction
  • -Seizures
  • -Stroke symptoms
• Dx:
  
  • -MRI with or without contrast = study of choice
  • -brain biopsy
• Tx:
  
  • Can be slow-growing or fast-growing (aggressive)
  • *Should be managed by experienced multidisciplinary team: medical oncology, radiation, neurosurgery
  • -Surgery, radiation, chemo

Question 2

Diffuse Midline Glioma

Answer 2

• Definition:
  
  • diffusely infiltrating astrocytic neoplasm
• Location:
  
  • pons, thalamus, & other midline structures
• Primarily Affects Children
• S/sxs:
  
  • CN deficits
  • -Spasticity
  • -Hyperreflexia
    *

Question 3

Ependymoma

Answer 3

• Definition:
  
  • Proliferation of ependymal cells develop in the lining of the ventricles & in the spinal cord, Most common in childhood & adolescence
• Anatomy:
  
  • Ependymal cells line the ventricles & parts of the spinal column.
• S/sxs:
  
  • Children: -N/V, HA
  • Infants: -increased size of cranium, irritability, vomiting & sleeplessness
• Dx:
  
  • CT or MRI with contrast
  • Brain Biopsy
• Tx:
  
  • Surgical Resection

Question 4

Oligodendroglioma

Answer 4

• Definition:
  
  • proliferation of oligodendrocytes in the brain
• Anatomy:
  
  • oligodendrocytes are a type of cell that make up the supportive (glial) tissue of the brain by producing myelin
• Location: cerebrum
• s/sxs:
  
  • Slow growing so may be asymptomatic
• Dx:
  
  • CT or MRI with contrast
  • -Brain biopsy: “Fried Egg” appearance
• Tx:
  
  • Rare. Slow growing & usually do not spread
  • -Surgical resection

Question 5

Meningioma

Answer 5

• Benign
• Definition:
  
  • slow-growing tumor arising from the meninges of the brain & spinal cord. Usually Benign
• S/sxs:
  
  • *insidious presentation
  • -Focal abnormalities
  • -Seizures
  • -Signs of Increased ICP
• Dx:
  
  • They are often quite large before they cause any symptoms. May be detected as incidental finding on brain MRI
  • MRI: well-defined lesion often attached to the dura
• Tx:
  
  • -Asymptomatic: observation if small
  • -Symptomatic: surgical excision when possible

Question 6

Medulloblastoma

Answer 6

• most common MALIGNANT posterior fossa tumor in children
• Definition:
  
  • proliferation of cells develop from embryonic or developing nerve cells that normally do not remain after birth
• location: cerebellum
• Epidemiology:
  
  • most common in children, M>F
• aka primitive neuroectodermal tumors (PNET)
• S/sxs:
  
  • N/V, HA, visual changes (diplopia), and unsteady walking or clumsiness
• Dx:
  
  • MRI and histologic evaluation of biopsy

Question 7

Schwannoma

Answer 7

• Definition:
  
  • benign tumors that begin in Schwann cells (which produce myelin for peripheral nerves). Slow-growing. Sxs caused by compression of affected nerve
• Location:
  
  • cranial & spinal nerve roots
• Epidemiology:
  
  • adults, F >M
• Vestibular schwannoma (acoustic neuroma) = most common

Question 8

Craniopharyngioma

Answer 8

• Definition:
  
  • slow-growing tumors that develop near the hypothalamus (usually suprasellar) → damage the hypothalamus
• Benign Tumor: can be considered malignant when they place pressure on the hypothalamus
• Epidemiology:
  
  • children & adolescents
• S/sxs:
  
  • Compress the optic chiasm
  • -Block the third ventricle: endocrine abnormalities, visual disturbances, hydrocephalus
    *

Question 9

Pineal Region Tumors

Answer 9

• Definition:
  
  • tumor occurring in or around the pineal gland
• Pineal Gland Secretes Melatonin & plays major role in the circadian rhythm
• Types:
  
  • Pineocytoma: slow-growing
  • -Pineoblastoma: fast-growing
• Tx:
  
  • Tumors often cannot be removed due to difficulty accessing the pineal region

Question 10

Cerebral Lymphoma

Answer 10

• Definition:
  
  • rare tumor thought to arise from brain histiocytes (microglia) or from rare lymphocytes that are normally present in the meninges & around blood vessels
• Most common in Immunocompromised pts but can occur in pts with an intact immune system
• S/sxs:
  
  • Focal neurological deficit
• Tx:
  
  • Complications = meningeal spread