Primary Brain Tumors Flashcards
Gender, % change
M > F (except meningiomas)
1% chance you’ll end up with brain tumor
Risk Factors
- radiation exposure *
- Family history or neurofibrotosis
- if immunosuppressed (HIV+ and on a lot of medications)
How are Brain tumors classified?
based on cell type (origin), and grade (based on mitosis rate)
Cell Types/origin of brain tumors
- Gliomas (most common)- glial cells
- Meningiomas (33%)- meninges
- Pituitary Tumors
- Neurolemmomas (8%)
- Medulloblastomas (children)
- Non-Hodgkins Lymphomas- HIV+, immunosuppressed pt
Types of Gliomas, ease of removal, location
Atrocytomas (20%) - hardest to remove, in parenchyma
Oligodendrogliomas (2%)- somewhat accessible, on the axons (on cranial nerves)
Ependymomas (2%)- easiest to remove, in ventricles
- lateral ventrical > 4th > 3rd (ease of removal)
Meningiomas, ease of removal, location
in the meninges (outside of brain), pretty easy to remove
Pituitary tumors, types
pituitary adenoma
pituitary carcinoma
craniopharyngioma
Neurolemmomas, location
sitting on the cranial nerves (schwannomas)
Grades of tumors: benign/malignant, prognosis, example
Grade 1 and 2: benign, good prognosis (low recurrence), meningiomas
Grade 3 and 4: malignant, poor prognosis, glioblastoma (grade 4)
how is malignancy determined in the brain?
by how fast the tumor is growing
Signs and Symptoms of CNS tumor
- increased intercerebral pressure
- New seizures *****
- Focal deficits based on location
- Personality changes
* signs and sx influenced by rate of growth; if slow, less signs and symptoms- the brain accomodates
Neuroimaging: MRI v CT
MRI: locating the tumor
CT: ensure there are no bleeds
First line of defense in treatment
surgery (if it is fast growing, will also need radiotherapy)
What is a stereotactic
titanium frame placed on pts head that provides exact loaction of tumor via longitude + lattitude
Method of shutting off blood supply to tumor
Catheter up through leg into the brain
injection of substance to stop bleeding to the area of the tumor
*avoids re-feeding the tumor and too much bleeding
Gamma Knife
pinpoint version of radiotherapy- useful when the tumor is inaccessible/in an area that is difficult to get to
Chemotherapy- surgical administration
Gliadel wafers: dissolvable, inserted before closing
Omaya reservoir: chemo into lateral ventrical via port
Holland: GBM survival rates
- biopsy only:
5yr survival rate: trend with age, deadliest, best prognosis
- 5yr survival decreases with age, no matter what the tumor is
GBM = deadliest
Meningioma = very good prognosis
Lab values to pay particular attention to
- electrolyte imbalance
- hormonal imbalance
- Hct (everyone with some degree of anemia post surgery)
- Platelets (excessive bleeding if they fall)
- Dilantin- anti-seizure medication; make sure they’re not having seizures if you see them
Signs of ICP
- sudden changes in status of alertness
- drastic difference in cog function from 1 day to the next
- behavior changes
- headache and lethargy
- seizures and vomitting
- neuro signs (weak, numb, dbl vision, eye problems)
Recovery v Compensation with a grade 4 tumor
more likely to be looking at compensation- kind of pt you brace when you see a foot drop
Paraneoplastic Conditions: definition, pathology
group of rare disorders triggered by abnormal immune system response to a cancerous tumor; cancery fighting antibodies or WBC mistakenly attach normal cells in the nervous system
Paraneoplastic Conditions: percentage of cancer pts, most common associated cancers
20% of cancer patients
lung, obvarian, lymphatic, or breast cancer
Paraneoplastic Neurologic Disorder
Paraneoplastic disorder that presents with neurological symptoms
*often these are the symptoms seen first, and this clues MDs in to looking for cancer throughout the body
Common neurologic signs of paraneoplastic neurologic disorder
difficulty with:
- walking
- balance
- speech
- hand tremor
- memory and mood disturbances
- lack of coordination
- weakness
Most common types of paraneoplastic neurologic disorders
- Paraneoplastic cerebellar degeneration (PCD)
- Opsoclonus-Myoclonus Syndrome (OMS)
- Eaton-Lambert Syndrome
- Paraneoplastic limbic encephalitis (PLE)
Opsoclonus-myoclonus Syndrome (OMS)
- affected system
- cancer associated with
- how to diagnose
- how to treat
- affects the oculomotor system
- associated with child neuroplastomas
- looks for a particular antibody
- responds to steroids
Eaton-Lambery Syndrome
- affected system
- presentation
- how to diagnose
- how to treat
- affects the limbs
- myasthenia syndrome, pt is weak (antibodies preventing ACH release, issue at NMJ)
- look for an ITG antibody
- treated like MG with cortocosteroids and plasamaphoresis
Paraneoplastic Limbic Encephalitis (PLE)
- affected system
- presentation
- affects the limbic system
- issues with anxiety, depression, agitation, emotional disturbances
paraneoplastic disorder: Diagnosis and treatment
diagnosed by tagging for specific antibodies in the blood. Imaging will not show anything. Must treat by finding the underlying cancer (can give medication, but issue will remain)
First places to look for cancer: lungs, ovaries, uterus
No cure! must find the cancer; rare to recover fully; after cancer removal, medications to decrease immune response (steroids, high-does IVG, or irradication- possible plasamaphoresis)
Affected Pituitary gland: clinical presentation
optic issues- pituitary gland sits over optic chiasm
Bitemporal hemianopsia
changes in hair growth
noticing some fertility issues
Faux Cerebre: clinical presentations
LE issues (BL or UL) –> pressing on cerebral cortex, specifically LE area (HAL)
Sylvian Fissure: Clinical presentations
facial and arm issues
Tentorium Cerebellum: clinical presentations
Ataxia
