Neurology: Tumors

Question 1

Describe a paraneoplasm.

Answer 1

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.

Question 2

What types of tumor are more common in children vs. adults.

Answer 2

Children: infratentorial (at or below brainstem and cerebellum)

Adults: supratentorial (above brainstem and cerebellum)

Question 3

Contrast agent used to enhance MRI images when searching for malignancy.

Answer 3

Gadolinium

Question 4

What test would you order to check for a paraneoplastic etiology of a tumor?

Answer 4

Blood test to look for autoantibodies

Question 5

What is the most common type of intracranial tumor?

Answer 5

Metastatic carcinoma

Question 6

Most common PRIMARY intracranial tumor.

Answer 6

Astrocytoma

Question 7

What is a glioblastoma multiforme?

Answer 7

Most aggressive primary intracranial tumor. High grade

Question 8

How is the prognosis determined for astrocytomas?

Answer 8

based on:
rate of tumor cell death (necrosis)
rate of tumor cell growth

Question 9

What structures are most commonly affected with brainstem gliomas?

Answer 9

CN (VI, VII, VIII, IX, X)
CST
4th ventricle

Question 10

What condition is linked to Optic Nerve gliomas?

Answer 10

Neurofibromatosis

NF is also linked to acoustic neuromas

Question 11

What are symptoms of Optic Nerve gliomas?

Answer 11

Visual
Hydrocephalus (blocked 3rd ventricle)
Endocrine (compression of pituitary gland)

Question 12

Name two specific medications stated in lecture to treat gliomas.

Answer 12

1. VEGF inhibitor

2. Irinotecan (topoisomerase inhibitor)

Question 13

Name 3 characteristics of oligodendrogliomas.

Answer 13

1. Mostly in young adults
2. Calcifications
3. Well-circumscribed

Question 14

Describe a medulloblastoma.

Answer 14

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.

Question 15

How does medulloblastomas spread and what is a consenquence of this?

Answer 15

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.

Question 16

Name the 3 most common sites of an ependymoma.

Answer 16

1. 4th ventricle
2. Cerebellopontine Angle (CP)
3. Spinal cord

Question 17

What cranial nerves are affected by an ependymoma at the CP angle?

Answer 17

CN V, VII, VIII

Question 18

What is a myxopapillary ependymoma?

Answer 18

Tumor in the filum terminale

Question 19

How do you treat a choroid plexus papilloma?

Answer 19

Often produces excess CSF: shunt

Resection to remove the growth

Question 20

What condition is linked to Acoustic Neuromas?

Answer 20

Neurofibromatosis

NF is also linked to optic neuromas

Question 21

Where do acoustic neuromas commonly arise?

Answer 21

CP angle

often affect CN V and CN VII

Question 22

What are symptoms of CN VIII neuromas?

Answer 22

Hearing loss, tinnitis, unsteady gait

Question 23

Why are meningiomas more common in women?

Answer 23

The tumor cells tend to have a lot of estrogen receptors that stimulate growth.

Question 24

How can a meningioma end up in the ventricular system?

Answer 24

During embryonic development, meningeal tissue can migrate into the ventricles.

Question 25

Who is most at risk for a Primary CNS Lymphoma?

Answer 25

Immunocompromised (AIDS patients)

Question 26

What is parinaud syndrome and what can cause it?

Answer 26

Paralysis of upgaze, accomodation, no light reaction, convergence, nystagmus.

Caused by Pinealoma

Question 27

What are the primary endocrine issues that occur with a pituitary tumor.

Answer 27

1. Prolactin Secretion (most common)

2. Growth Hormone Secretion (second most common)

Question 28

What CN are most affected by pituitary tumors?

Answer 28

CN II
-direct compression

CN III, IV, VI
-all pass thru the cavernous sinus which can be compressed by pit. tumor.

Question 29

How would you distinguish a pituitary tumor from a carotid aneuysm?

Answer 29

Blood test for hormone levels.

Both headaches would be progressive

Question 30

Treatment for a prolactin secreting pituitary tumor.

Answer 30

Bromocriptine (DA agonist)

Question 31

Describe a colloid cyst.

Answer 31

Comes from paraphysis (anterior and superior portion of the 3rd ventricle).

Oval or round, gelatinous, green tumor.

Can cause hydrocephalus, headache, coma, or death

Question 32

Describe von Hippel Lindau Disease.

Answer 32

Hemangioblastoma of cerebellum.
Associated with angiomas in retina, liver, and pancreatic cysts.

Associated with polycythemia due to increased erythropoietin secretion

Question 33

Most common sites of cancer that metastasize to the brain.

Answer 33

Lung, Breast, Melanoma

Question 34

What are two treatments for leptomeningeal carcinomatosis?

Answer 34

1. Radiation

2. Intrathecal Chemotherapy (injected into CSF)

Question 35

Name 5 paraneoplastic syndromes.

Answer 35

1. Lambert Eaton
2. Dematomyositis
3. Limbic Encephalitis
4. Acute cerebellar degeneration
5. Motor Neuropathy

Question 36

Name 5 cancers assocaited with paraneoplastic syndromes.

Answer 36

1. Ovarian
2. Testicular
3. GI
4. Small Cell Lung
5. Lymphoma