Neuropathology Flashcards
Presentation of Brain tumours
- Often asymptomatic esp. when small
- Signs and symptoms of raised ICP
What is raised intracranial pressure
Anything that takes up additional space within the skull will increase the pressure in the intracranial space
Causes of raised ICP
Brain tumours
Intracranial haemorrhage
Idiopathic intracranial hypertension
Abscesses or infection
Concerning features of a head ache that should prompt further investigation
Constant Nocturnal Worse on waking Worse on coughing, straining or bending forward Vomiting
Features of Raised ICP
Altered mental state Visual field defects Seizures (particularly focal) Unilateral ptosis Third and sixth nerve palsies Papilloedema (on fundoscopy)
What is papilloedema
- swelling of the optic disc secondary to raised intracranial pressure
- can be seen on fundoscopy
- CSF under high pressure flows into the optic nerve sheath.
What can be seen on fundoscopy in raised ICP
Blurring of the optic disc margin
Elevated optic disc (look for the way the retinal vessels flow across the disc to see the elevation)
Loss of venous pulsation
Engorged retinal veins
Haemorrhages around optic disc
Paton’s lines which are creases in the retina around the optic disc
Which cancers commonly metastasise to the brain
Lung
Breast
Colorectal
Prostate
What are Gliomas
Gliomas are tumours of the glial cells in the brain or spinal cord. There are three types to remember ( most to least malignant):
Astrocytoma (glioblastoma multiforme is the most common)
Oligodendroglioma
Ependymoma
What are meningiomas
Meningiomas are tumours growing from the cells of the meninges in the brain and spinal cord. They are usually benign, however they take up space and this mass effect can lead to raised intracranial pressure and neurological symptoms.
What is the treatment of pituitary tumours
Trans-sphenoidal surgery
Radiotherapy
Bromocriptine to block prolactin secreting tumours
Somatostatin analogues (e.g. ocreotide) to block growth hormone secreting tumours
Pituitary tumours have the potential to cause hormone deficiencies (hypopituitarism) or to release excessive hormones leading to:
Acromegaly
Hyperprolactinaemia
Cushing’s disease
Thyrotoxicosis
What is the key features of pituitary tumours
- Tend to be benign.
- Can press on the optic chiasm causing: bitemporal hemianopia. This causes loss of the outer half of the visual fields in both eyes.
What are Acoustic Neuroma (AKA Vestibular Schwannoma)
- Tumours of the Schwann cells surrounding the auditory nerve that innervates the inner ear.
- occur around the “cerebellopontine angle”
- growing but eventually grow large enough to produce symptoms and become dangerous.
- usually unilateral
- Bilateral: associated with neurofibromatosis type 2.
What are the common symptoms of Acoustic Neuroma (AKA Vestibular Schwannoma)
Hearing loss
Tinnitus
Balance problems
Facial nerve palsy
What is neuropathic pain
abnormal functioning of the sensory nerves delivering abnormal and painful signals to the brain.
What is the presentation of neuropathic pain
Burning Tingling Pins and needles Electric shocks Loss of sensation to touch of the affected area
What causes neuropathic pain
Postherpetic neuralgia from shingles is in the distribution of a dermatome and usually on the trunk
Nerve damage from surgery
Multiple sclerosis
Diabetic neuralgia typically affects the feet
Trigeminal neuralgia
Complex Regional Pain Syndrome (CRPS)
What assessment tool is used to assess whether pain is neuropathic in natures
DN4 questionnaire
What is the firt line management of neuropathic pain
Amitriptyline: tricyclic antidepressant Duloxetine: SNRI antidepressant Gabapentin: anticonvulsant Pregabalin: anticonvulsant Only use one at a time
What are alternative methods to manage neuropathic pain
- Tramadol ONLY as a rescue for short term control of flares Capsaicin cream (chilli pepper cream) for localised areas of pain Physiotherapy to maintain strength Psychological input to help with understanding and coping
What is complex regional pain syndrome
- Abnormal nerve functioning causing neuropathic pain and abnormal sensations
- isolated to one limb
- Often it is triggered by an injury to the area
what are the key features of complex regional pain syndrome
- very painful and hypersensitive
- Intermittently swell
- change colour
- change temperature
- flush with blood
- abnormal sweating.
What is the management of complex regional pain syndrome
- pain specialist
- similar to other neuropathic pain.
What is neurofibromatosis
- genetic condition that causes nerve tumours (neuromas) to develop throughout the nervous system
- Tumours are benign, but cause neurological and structural problems