Neurology: Tumors Flashcards
Describe a paraneoplasm.
Antibody mediated damage to cells in the brain leading to unregulated growth. Occurs secondary to some kind of immune response in which the antibodies made to the primary insult resemble brain tissue.
What types of tumor are more common in children vs. adults.
Children: infratentorial (at or below brainstem and cerebellum)
Adults: supratentorial (above brainstem and cerebellum)
Contrast agent used to enhance MRI images when searching for malignancy.
Gadolinium
What test would you order to check for a paraneoplastic etiology of a tumor?
Blood test to look for autoantibodies
What is the most common type of intracranial tumor?
Metastatic carcinoma
Most common PRIMARY intracranial tumor.
Astrocytoma
What is a glioblastoma multiforme?
Most aggressive primary intracranial tumor. High grade
How is the prognosis determined for astrocytomas?
based on:
rate of tumor cell death (necrosis)
rate of tumor cell growth
What structures are most commonly affected with brainstem gliomas?
CN (VI, VII, VIII, IX, X)
CST
4th ventricle
What condition is linked to Optic Nerve gliomas?
Neurofibromatosis
NF is also linked to acoustic neuromas
What are symptoms of Optic Nerve gliomas?
Visual
Hydrocephalus (blocked 3rd ventricle)
Endocrine (compression of pituitary gland)
Name two specific medications stated in lecture to treat gliomas.
- VEGF inhibitor
2. Irinotecan (topoisomerase inhibitor)
Name 3 characteristics of oligodendrogliomas.
- Mostly in young adults
- Calcifications
- Well-circumscribed
Describe a medulloblastoma.
Tumor that arises from the granular layer of the cerebellum and usually reside in the vermis. Affects the 4th ventricle resulting in increased ICP and ataxia.
How does medulloblastomas spread and what is a consenquence of this?
Leptomeningeal spread: spreading of tumors thru the CSF.
Consequence: when treating with radiation you have to irradiate the whole neural axis to ensure all tumor cells are killed.
Name the 3 most common sites of an ependymoma.
- 4th ventricle
- Cerebellopontine Angle (CP)
- Spinal cord
What cranial nerves are affected by an ependymoma at the CP angle?
CN V, VII, VIII
What is a myxopapillary ependymoma?
Tumor in the filum terminale
How do you treat a choroid plexus papilloma?
Often produces excess CSF: shunt
Resection to remove the growth
What condition is linked to Acoustic Neuromas?
Neurofibromatosis
NF is also linked to optic neuromas
Where do acoustic neuromas commonly arise?
CP angle
often affect CN V and CN VII
What are symptoms of CN VIII neuromas?
Hearing loss, tinnitis, unsteady gait
Why are meningiomas more common in women?
The tumor cells tend to have a lot of estrogen receptors that stimulate growth.
How can a meningioma end up in the ventricular system?
During embryonic development, meningeal tissue can migrate into the ventricles.
Who is most at risk for a Primary CNS Lymphoma?
Immunocompromised (AIDS patients)
What is parinaud syndrome and what can cause it?
Paralysis of upgaze, accomodation, no light reaction, convergence, nystagmus.
Caused by Pinealoma
What are the primary endocrine issues that occur with a pituitary tumor.
- Prolactin Secretion (most common)
2. Growth Hormone Secretion (second most common)
What CN are most affected by pituitary tumors?
CN II
-direct compression
CN III, IV, VI
-all pass thru the cavernous sinus which can be compressed by pit. tumor.
How would you distinguish a pituitary tumor from a carotid aneuysm?
Blood test for hormone levels.
Both headaches would be progressive
Treatment for a prolactin secreting pituitary tumor.
Bromocriptine (DA agonist)
Describe a colloid cyst.
Comes from paraphysis (anterior and superior portion of the 3rd ventricle).
Oval or round, gelatinous, green tumor.
Can cause hydrocephalus, headache, coma, or death
Describe von Hippel Lindau Disease.
Hemangioblastoma of cerebellum.
Associated with angiomas in retina, liver, and pancreatic cysts.
Associated with polycythemia due to increased erythropoietin secretion
Most common sites of cancer that metastasize to the brain.
Lung, Breast, Melanoma
What are two treatments for leptomeningeal carcinomatosis?
- Radiation
2. Intrathecal Chemotherapy (injected into CSF)
Name 5 paraneoplastic syndromes.
- Lambert Eaton
- Dematomyositis
- Limbic Encephalitis
- Acute cerebellar degeneration
- Motor Neuropathy
Name 5 cancers assocaited with paraneoplastic syndromes.
- Ovarian
- Testicular
- GI
- Small Cell Lung
- Lymphoma
