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Yr 5 - A&E > Revision - Space Occupying Lesions & Cerebral Venous Thrombosis > Flashcards

Revision - Space Occupying Lesions & Cerebral Venous Thrombosis Flashcards

1
Q

Location of majority of brain tumours in adults vs children?

A

Adults –> supratentorial (i.e. cerebrum)

Children –> infratentorial (i.e. cerebellum)

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2
Q

which cancer most commonly spreads to brain?

A

lung

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3
Q

What is the most common 1ary brain tumour in adults?

A

Glioblastoma

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4
Q

Unusual changes in personality and behaviour would indicate a brain tumour in what location?

A

Frontal lobe

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5
Q

What are glial cells?

A

They surround and support the neurones:

1) Astrocytes
2) Oligodendrocytes
3) Ependymal cells

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6
Q

What is a glioma?

A

Tumour of the glial cells in the brain or spinal cord

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7
Q

How gliomas graded?

A

1-4 depending on severity

4 is most malignant (glioblastoma multiforme)

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8
Q

What are the 3 types of gliomas?

A

1) astrocytoma
2) oligodendroglioma
3) ependymoma

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9
Q

What type of glioma is a glioblastoma multiforme?

A

Astrocytoma

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10
Q

Prognosis of a glioblastoma?

A

Around 1 year

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11
Q

How do glioblastomas appear on imaging?

A

Solid tumour with central necrosis and rim that enhances with contrast.

Associated with vasogenic oedema due to disruption of blood brain barrier.

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12
Q

Histology of a glioblastoma?

A

Pleomorphic tumour cells border necrotic cells

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13
Q

What do meningomas arise form?

A

Dura mater of the meninges

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14
Q

Are meningiomas usually benign or malignant?

A

Usually benign

However, they take up space –> can lead to raised intracranial pressure and neurological symptoms

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15
Q

Histology of meningiomas?

A

Spindle cells in concentric whorls and calcified psammoma bodies

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16
Q

What is the most common 1ary brain tumour in children?

A

Pilocytic astrocytoma

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17
Q

Histology of a pilocytic astrocytoma?

A

Rosenthal fibres (corkscrew eosinophilic bundle)

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18
Q

What is a medulloblastoma?

A

An aggressive paediatric tumour that arises within the infratentorial compartment.

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19
Q

How does a medulloblastoma spread?

A

Through CSF

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20
Q

Where is an ependymoma commonly seen?

A

In the 4th ventricle

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21
Q

What may an ependymoma cause?

A

Hydrocephalus

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22
Q

Where are oligodendromas typically found?

A

Frontal lobes

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23
Q

What is a haemangioblastoma?

A

A vascular tumour of the cerebellum

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24
Q

What condition are haemangioblastomas associated with?

A

von Hippel-Lindau syndrome

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25
Q

Hearing loss in a vestibular schwannoma?

A

Sensorineural

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26
Q

Typical presentation of a vestibular schwannoma?

A

1) typically 40-60 y/o

2) unilateral sensorineural hearing loss

3) unilateral tinnitus

4) dizziness or imbalance

5) sensation or fullness in ear

6) facial nerve palsy (if the tumour grows large enough to compress the facial nerve)

27
Q

What is the most common paediatric SUPRAtentorial tumour?

A

Craniopharyngioma

28
Q

What is the 1st line investigation in patients with a possible brain tumour?

A

MRI

29
Q

What drugs can cause idiopathic intracranial HTN?

A

1) COCP

2) Steroids

3) Tetracyclines

4) Lithium

5) Retinoids

30
Q

Management of idiopathic intracranial HTN?

A

1) weight loss

2) carbonic anhydrase inhibitors e.g. acetazolamide

3) topiramate (has the added benefit of causing weight loss in most patients)

4) repeated lumbar puncture may be used as a temporary measure but is not suitable for longer-term management

5) surgery

31
Q

Role of carbonic anhydrase inhibitors (eg, acetazolamide) in idiopathic intracranil hypertension?

A

Can reduce CSF production at choroid plexus

32
Q

Which cranial nerve is most common affected by traumatic brain injury and/or elevated ICP?

A

CN VI (abducens)

33
Q

What is cerebral venous thrombosis caused by?

A

Partial or total occlusion of the cerebral veins and sinuses by a thrombus.

34
Q

What are some genetic thrombophilias that can predispose to CVT?

A

1) APS
2) Antithrombin III deficiency
3) Protein C deficiency
4) Protein S deficiency
5) Factor V Leiden
6) Hyperhomocysteinemia

35
Q

What is the most common cause of infection causing CVT?

A

Staph aureus - spread from infection of the sinuses

36
Q

Give 3 examples of infections causing CVT

A

1) Staph. aureus from sinusitis

2) Meningitis

3) Subdural empyema

37
Q

Give 2 procedures that can cause CVT

A

1) Jugular venous cannulation

2) LP

38
Q

Give some examples of chronic inflammatory diseases that can cause CVT

A

1) SLE
2) IBD
3) Sarcoid
4) Granulomatosis with polyangiitis

39
Q

What medication increases the risk of CVT?

A

Steroids

40
Q

What is the 1ary mechanism of injury in CVT?

A

1) a cerebral vein or sinus becomes partially or totally occluded by a venous thrombus

2) deoxygenated blood will begin to pool within the brain parenchyma

3) this causes an increase in cerebral venous pressure

41
Q

Resulting complications from CVT?

A

1) cerebral ischaemia

2) oedema

3) haemorrhage

4) raised ICP

42
Q

Symptoms of CVT?

A

1) headache

2) seizures

3) focal neurological deficits:
- hemiparesis
- fluent aphasia
- sensory/visual field defects

4) changes in metnal state:
- encephalopathy

Symptoms will vary depending upon the site and extent of thrombosis.

43
Q

What is the most common site of CVT?

A

Sagittal sinus thrombosis (60%)

44
Q

How does sagittal sinus thrombosis typically present?

A

Most commonly presents with bilateral motor deficits and seizures

45
Q

Which sinus is most likely to be affected by septic CVT?

A

Cavernous sinus - with infection spreading from nearby sinuses, nose and middle ear

46
Q

CVT can be classified into what two categories depending upon its aetiology?

A

1) aspectic CVT

2) septic CVT

47
Q

What is aseptic CVT?

A

An embolism arising from a non-infective cause, often due to underlying hypercoagulable state but has a variety of causes.

This is the most common type of CVT

48
Q

Where does aspetic CVT typically occur?

A

Superior sagittal sinus

49
Q

What is septic CVT?

A

An embolism arising from a primary source of infection, most commonly sinusitis, osteomyelitis, otitis media or rarely septicaemia.

50
Q

Where does septic CVT typically occur?

A

Cavernous sinus

51
Q

What is the most frequent symptom experienced by CVT patients?

A

Headache

52
Q

1st line investigation in suspected CVT?

A

MRI + MR venography

53
Q

Management of CVT involves what 3 key elements?

A

1) acute antithrombotic therapy

2) acute symptom management

3) long term management

54
Q

What is used for acute antithrombotic therapy in CVT?

A

LMWH or UH

55
Q

What does acute symptom management involve in CVT?

A

1) Raised ICP:
- bed elevated
- osmotic therapy (mannitol or hypertonic saline)
- brain herniation may need emergency decompressive surgery

2) Seizures: anticonvulsants

3) Infection/inflammation: Abx, steroids

56
Q

Mx of raised ICP?

A

1) elevate bed

2) osmotic therapy: IV mannitol or hypertonic saline

57
Q

Long term management of confirmed CVT?

A

Long-term mx with warfarin

58
Q

What is anticoagulant of choice for long-term mx in CVT?

A

Warfarin

59
Q

INR target in patients on warfarin in CVT?

A

2.5

60
Q

How long is warfarin continued for in CVT?

A

Provoked CVT –> 3-6 months

Unprovoked CVT –> 6-12 months

61
Q

Which artery is typically affected in temporal arteritis that causes vision loss?

A

Occlusion of the posterior ciliary artery (a branch of the ophthalmic artery) –> ischaemia of the optic nerve head.

62
Q

What will a temporal artery biopsy show in temporal arteritis?

A

Multinucleated giant cells –> skip lesions may be present

63
Q
A

Yr 5 - A&E (13 decks)

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