Oncology and Neuroinfections Flashcards
Neoplasm
-benign or malignant expanding lesion
CNS Tumors and Cancer
-2nd MC death in children: posterior fossa
-2nd MC cause of death in males 20-39y: cerebral hemipheres
-women: MC meningeal tumors
Clinical Presentation:
-s/s of tumor, edema, injury to surrounding tissue
-focal or generalized
S/s:
-seizures
-location dependent
-HA
-increased cranial pressure
Brain Tumor Sites
Frontal: personality, Brocas aphasia, urinary frquency, seizures, hemiparesis
Frontoparietal: Hemiparesis/sensory, wernickes aphasia
Parietal: Hemisensory, werenickes aphasia, neglect (non dom), homo hemianopsia
Occipital: homo hemianopsia, visual agnosas
Temporal: aphasia, memory, sup quadrantonopsia
Increased Intracranial Pressure
-hydrocephalus
S/s:
-headache
-worse in AM and bending over
-nausea
-increased ventricles (massive)
Classification of Tumors
-genetics determine prognosis
Brain:
-Supratentorial: cortex, frontal (MC), temporal
-Infratentorial: cerebellar and BS
Spinal:
-Intramedullar: within SC
-Extramedullary/intradural: on surface of cord
-Extradural: in epidural space, can compress
-Gliomas: resemble glial cells
-Meningiomas: arise from arachnoid cells (MC)
Neuroblastomas/neurocytomas: from neurons
-Medulloblastomas: from primitive cells medulloblasts
Glioma Classification
- Pilocytic Astrocytoma: benign, slow
- Low Grade Astrocytoma: non replicating, increased cellularity
- Anaplastic Astrocytoma: high replication, high cellularity
- Glioblastoma: high replication, high cellularity, vascular proliferation and necrosis
Astrocytoma
-25-45y
-usually in cerebral hemispheres
-1-3
S/s:
-seizures (good outcomes if only), HA
Outcome:
-9-17yrs
-80% at 5 yrs
Tx:
-surgery, radiation, chemo
Glioblastoma
-men, 59yrs
-4
-in cortex
S/s:
-focal signs, cognitive changes, increased ICP
-irregular cystic mass on MRI
Outcome:
-older=worse prognosis
-high level of function @ diagnosis=good
Tx:
-steroids
-surgery
-high dose radiation/chemo
-tumor treating field: targets mitosis of cancer cells
Medulloblastomas
-23% tumors and children
-peak age at 6
-in cerebellum
-more posterior
S/s:
-CN
-obstructs 4th ventricle
-ataxia
-high ICP
-spreads to SC
Outcome:
-33-60% 10 yrs
-recurremce in posterior
-extracranial metastases worse
Tx:
-resection
-med dose radiation/chemo
Meningiomas
-MC brain primary tumor
-F>M
-arise from arachnoid cells
-calcification common, asymptomatic
Metastasis to CNS
-30% of cancer pts develop CNS
-50% is symptomatic
-70% thoracic, 20% lumbar, 10% cervical
Primary Sites:
-lungs
-breast
-melanoma
Metastatic Disease
-multiple masses in brain at grey/white junction
-SC: prognosis of ambulation depends on state @ diagnosis
S/s:
-increased ICP
-Seizures
-Back pain/tenderness
-Paraparesis
-Incontinence
Tx:
-dependent on location and presentation
-steroids, radiation
Leptomeningeal Metastases
-coating of tumor along the meninges
-bad prognosis <6m
S/s:
-ataxia
-CN defects
-polyradiculopathy
Paraneoplastic Disorders
-heterogenous group of disorders ass with cancer
-autoimmuity reaction to cancer/antibodies
-polyneuropathy
-dermatomyositis (high prob of cancer)
-encephalitis
-lambert eaton
Complications of Treatment
Chemotherapy:
-neuropathy
-delirum
-dementia
-seizures
-HA
Radiation:
-HA
-neuro s/s worsening
-radiatio necrosis
-cognitive impairment
Types of CNS Infection
-Meningitis
-Encephalitis (in parenchyma)
-Abscess Brain and SC
-ring enhancing lesion
Entry:
-hematogenous spread
-infected cranial structures
-penetrating injuries
-surgical invasion
Meningitis
-bacteria excite acute inflammatory reaction
-vessels may thrombose
-exudate may back up
S/s:
-infection signs
-HA
-neck pain and stiffness
-convulsions
-confusion
Infants: bulging fontanels
-cloudy lumbar puncture
Meningeal Signs:
-Kernig’s sign: flx hip and ext knee causes pain
-Brudzinski’s neck sign: flx neck causes flx of hips and knees
Tx:
-antibiottics
-10-21d
Meningococcal Meningitis
-epidemics
-rapid over hours
-skin rash
Mortality:
-10% with tx
-50% w/o
Viral (aseptic) Meningitis
-fever, HA, meningal irritation
-CSF with lymphocytic dominance
Causes:
-enterovirus, herpes (acyclovir only treatment and only for herpes), syphillus, lyme
Acute Encephalitis
-fever, impairied consciousness, seizures, ataxia, CN palsies
-usually meningeal
Herpes Simplex Encephalitis
-most serious of viral enxephalitides
-fever, confision, coma
-temporal and frontal
Tx:
-IV Acyclovir
Tuberculous Meningitis
-organism reaches BBB
-basal meningities
-tubercles
-hydrocephalus and stroke
-CN palsies
Subdural Empyema
-purulent infection of subdural space
-disease of sinuses in middle
-meningeal veins thrombose cause infarction
S/s:
-HA, fever, focal signs, hemiparesis
-Increased ICP
-pus
Tx:
-drainage
Intracranial Thrombophlebitis
-infection leading to thrombosis of venus system
-increased ICP
Tx:
-surgery or antibiotics
