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Y2 Neurology > Pathology of Brain Tumours > Flashcards

Pathology of Brain Tumours Flashcards

1
Q

what is contained in the cranium ?

A 
brain 
meninges
dural folds 
blood 
CSF
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2
Q

what is the pressure gradient ?

A

P1 - P2

for examples the arterial pressure and the venous pressure

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3
Q

what does CPP stand for?

A

cerebral perfusion pressure

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4
Q

what does the CPP reflect?

A

reflects the pressure gradient to get into the cranium

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5
Q

how do you calculate the CPP?

A

CPP = MAP - ICP

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6
Q

how do you calculate the cerebral blood flow ?

A

CBF = CPP/CVR

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7
Q

what mechanism is there that makes sure CBF remains constant as the CPP changes ?

A

auto regulation

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8
Q

what is cushings triad ?

A
  • decrease in heart rate
  • decrease in resp. rate
  • increase of BP
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9
Q

when does cushings reflex occur?

A

cushings reflex is a late reflex which occurs when CBF is low to ensure that CPP is maintained

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10
Q

how does auto regulation maintain CBF?

A

maintained by changing the diameter of the vessels

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11
Q

when CPP increases what happens to the radius of vessels and why?

A

CPP increases

the diameters decrease to increase resistance and hence decrease cerebral blood flow to optimum level

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12
Q

when CPP decreases what happens to the radius of vessels and why?

A

CCP decreases

the diameters increase so the resistance is less and hence the blood flow will increase back to optimum

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13
Q

what shape is the auto regulation graph of CPP and CBF ?

A

sigmoid graph

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14
Q

under what CPP does the brain start to become ischaemic and loss function ?

A

<50mmHg

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15
Q

at which CPP does brain oedema occur due to hypertension ?

A

> 150mmHg

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16
Q

what are four causes of raised ICP?

A

inflammation
vascular
tumours
hydrocephalus

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17
Q

state some vascular disorders which could cause raised ICP ?

A

intracranial haemorrhage
brain swelling due to trauma
hypotension due to cardiac arrest

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18
Q

what are the three opening in the brain where herniation can occur?

A

subfalcine space
tentorial hiatus
foramen magnum

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19
Q

what abouts in the skull does a subfalcine hernia occur?

A

inferior border of the falx cerebri just superior to the lateral ventricles

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20
Q

what structure sits in the tentorial hiatus ?

A

the brain stem

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21
Q

when the cerebellum passes through the foramen magnum what is this called?

A

cerebellar coning

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22
Q

when there is raised ICP, what happens to the CBF and why?

A

CBF decreases as the pressure gradient outside and inside the skull is less

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23
Q

when the cerebrum herniates inferiorly and medially through the tentorium what is this called?

A

uncle grooving

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24
Q

what type of hernia is it when the brain pushes through the skull following a fracture ?

A

transcalvarial

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25
Q

what three tests and investigations can be done to test for loss of function due to a tumour and hence raised ICP?

A

Glasgow Coma Scale
Pupillary dilation
Localising signs such as weakness in one arm

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26
Q

what cranial nerve is affected when there is a fixed dilated pupil?

A

Nerve 3 - oculomotor

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27
Q

are brain tumours more common type of tumour in adults or children?

A

brain tumours is the 2nd most common ground of tumour in children

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28
Q

where abouts in the brain are the majority of brain tumours in adults ?

A

70% above the tentorium

29
Q

where abouts in the brain are the majority of brain tumours in children ?

A

70% below the tentorium

30
Q

are brain tumours in children more likely to be primary or secondary ?

A

nearly all are primary in children

31
Q

what percentage of brain tumours are primary in adults ?

A

65%

32
Q

where are the common places secondary brain tumours have spread from ?

A 
breast
lung 
kidney 
colon 
melanoma
33
Q

where are the 7 locations a brain tumour can occur?

A 
glial cells
primitive neurorectoderm 
arachnoidal cell
nerve sheath cell
pituitary gland 
lymphoid cell 
capillary vessels
34
Q

what is a pituitary gland tumour called ?

A

adenoma

35
Q

what are the clinical complications of pituitary gland tumour ?

A

loss of endocrine function

may extend up to the optic chiasma

36
Q

what is a tumour os the capillary vessels called?

A

haemangioblastoma

37
Q

what are the two types of nerve sheath cell tumours called?

A

schwannoma

neurofibroma

38
Q

are schwann cells found in the CNS or PNS ?

A

PNS

39
Q

what type of cell in the CNS produces myelin?

A

oligodendrocyte

40
Q

what is a tumour of arachnoidal cells called?

A

meningioma

41
Q

are medulloblastoma more common in children or adults ?

A

children

42
Q

from what cells does medulloblastoma originate from ?

A

primitive neurorectoderm

43
Q

what are the four types of glial cell tumours ?

A

glioblastoma
astrocytoma
oligodendroglioma
ependymoma

44
Q

what is ischaemic penumbra ?

A

area of ischaemia around a tumour

45
Q

what is the clinical significance of ischaemic penumbra ?

A

the ischaemia around the tumour can be removed to improve function of the brain tissue

46
Q

what is the function of glial cells?

A

CNS supporting cells

  • providing myelin
  • providing a favourable environment for neurones
47
Q

do glioma spread around the body ?

A

no stays in the CNS

48
Q

are glioma encapsulated ?

A

no they have diffuse edges

49
Q

what is the prognosis of glioma ?

A

high grade glioma grow fast and respond poorly to surgery

- survival time = 36 weeks

50
Q

can people live their entire life with low grade glioma without any complications?

A

yes

51
Q

state a treatable complication of low grade glioma ?

A

epilepsy can be triggered

52
Q

in which fossa does medulloblastoma usually occur ?

A

posterior fossa especially in the brain stem

53
Q

what is the prognosis of medulloblastoma ?

A

poor prognosis due to deep location and difficult access for surgery

54
Q

are meningiomas benign or malignant ?

A

benign

55
Q

how can meningiomas invade the skull?

A

via emissionary veins

56
Q

what is the most common nerve sheath tumour ?

A

acoustic neuroma

57
Q

what cranial nerve is affected by an acoustic neuroma ?

A

CN 7

58
Q

what is a symptom of acoustic neuroma ?

A

unilateral deafness

59
Q

what are two clinical signs that a patient may have a pituitary adenoma ?

A

acromegaly

giantism

60
Q

what is the prognosis of CNS lymphoma ?

A

poor

  • often deep and central site
  • difficult to biopsy
  • difficult to treat due to BBB
61
Q

do CNS lymphomas spread out of the CNS ?

A

no

62
Q

is there any lymph tissue in the brain ?

A

no

63
Q

what cell makes up a CNS lymphoma ?

A

B cell lymphoma

64
Q

where do capillary haemangioblastomas often occur ?

A

cerebellar hemispheres

65
Q

what are the complications of capillary haemangioblastomas ?

A

may bleed
space occupying
difficult to get to

66
Q

are secondary tumours mostly malignant or benign?

A

malignant

67
Q

what are secondary tumours often surrounded by ?

A

they are encapsulated surrounded by oedema

68
Q

are primary and secondary tumour histology similar ?

A

yes

Y2 Neurology (52 decks)

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