Neuropathology 3 (brain tumors+seizures)

Question 1

Name 5 brain tumors found in the cerebellopontine angle?

Answer 1

The cerebellopontine angle i s the
angle formed by the cerebellum,
pons, and medulla. Five brain
tumors are often found here
(SAM EE):
1. Schwannoma {75%)
2. Arachnoid cyst ( 1 %)
3. Meningioma (1 0%)
4. Ependymoma ( 1 %)
5. Epidermoid (5%)

Question 2

PSaMMoma bodies are associated

with :

Answer 2

-- Papillary adenocarcinoma
(thyroid)
 -- Papillary Serous
cystadenocarcinoma (ovary)
-- Meningioma
-- Mesothelioma

Question 3

Glioblastoma multiforme: Age group?

Presentation? Incidence? Prognosis?

Answer 3

• Adult peak incidence
• “Pseudopalisading” tumor cells border central areas of necrosis
• Cerebral hemispheres, may cross corpus collusum –>butterfly glioma
• Stain astrocytes for GFAP
• Grade IV astrocytoma
• Prognosis

Question 4

Meningioma: Age group?

Presentation? Incidence? Histology? Prognosis?

Answer 4

-Common, typically benign 1° brain tumoR, occurs in convexities of hemispheres (near
surfaces of brain) and parasagittal region. -Arises from arachnoid cells
-Histology: spindle cells, whorled pattern; psammoma bodies
-adults, new onset focal seizures

Question 5

Schwannoma (neurofibroma): Age group?

Presentation? Incidence? Histology? Prognosis?

Answer 5

-adult
-at cerebellopontine angle, but can be along any peripheral nerve except CN I, and II-
-Schwann cell origin H, S-100 ⊕; often localized to CN VIII –> vestibular schwannoma. -Resectable or treated
with stereotactic radiosurgery.
-Bilateral vestibular schwannomas found in NF-2.

Question 6

Oligodendroglioma: Age group?

Presentation? Incidence? Histology? Prognosis?

Answer 6

• adult
• slow growing, often frontal lobes, rare tumor
• fried egg cells, round nuclei with clear cytoplasm-often calcified

Question 7

Pituitary adenoma? Age group?

Presentation? Incidence? Histology? Prognosis?

Answer 7

• Most commonly prolactinoma
• Bitemporal hemianopia due to pressure on optic chiasm.
• Hyper- or hypopituitarism are sequelae.
• Resection using surgery
• Access via sphenoid sinuses

Question 8

Pinealoma? Age group?

Presentation? Incidence? Histology? Prognosis?

Answer 8

• adults
• Compress superior colliculus - causing Parinaud syndrome, pretectal area, and aqueduct (hydrocephalus)
• interrupt melatonin production - circadian rhythm abnormalities, insomnia, precocious puberty

Question 9

Pilocytic low grade astrocytoma: Age group?

Presentation? Incidence? Histology? Prognosis?

Answer 9

-children
-Usually well circumscribed, benign glioma
-in posterior fossa (e.g. cerebellum).
-GFAP ⊕.
-Histo: Rosenthal fibers—eosinophilic,corkscrew
fibers
-Benign; good prognosis.

Question 10

Medulloblastoma: Age group?

Presentation? Incidence? Histology? Prognosis?

Answer 10

• Highly malignant cerebellar vermis tumor, primitive neuroectodermal tumor.
• Can compress 4th ventricle–>hydrocephalus.
• Rosettes, perivascular pattern
• small round blue cells
• ataxia, nuchal rigidity, projectile vomiting, increased ICP
• radiosensitive

Question 11

Ependymoma: Age group?

Presentation? Incidence? Histology? Prognosis?

Answer 11

-Ependymal cell tumors most commonly found
in 4th ventricle
-Can cause hydrocephalu
-perivascular psedorosettes, rod-shaped blepharoplasts near nucleus
Poor prognosis.

Question 12

Craniopharyngioma

Answer 12

-Benign childhood tumor, may be confused with pituitary adenoma (both can cause bitemporal hemianopia).
-Most common childhood supratentorial tumor.
-Derived from remnants of Rathke pouch.
Calcification is common

Question 13

What are partial seizures?

Name two partial seizures and characteristics?

Answer 13

-Affect single area of the brain. Most commonly
originate in medial temporal lobe. Often
preceded by seizure aura
-Simple: consciousness intact with motor, sensory, autonomic, and psychic features
Complex: impaired consciousness + components of simple

Question 14

Treatment of partial seizures?

Answer 14

• Simple: Carbamazepine, valproic acid, gabapentin, lamotrigine, topiramate, phenobarbital, tiagabine, vigabatrin, leveticetam
• Complex: same, esp. carbamazepine

Question 15

What are generalized seizures?

Name 4 and characteristics?

Answer 15

Diffuse.
ƒ -Absence (petit mal)—3 Hz, no postictal
confusion, blank stare
-ƒ Myoclonic—quick, repetitive jerks
ƒ -Tonic-clonic (grand mal)—alternating
stiffening and rhythmic jerking movements
ƒ -Tonic—stiffening
ƒ -Atonic—“drop” seizures (falls to floor);
commonly mistaken for fainting

Question 16

May-White syndrome?

Answer 16

Familial progressive myoclonic (quick, repetitive jerks) epilepsy acc. by lipoma, ataxia, and deafness