Rothrock: CNS Tumor Neuropsych

Question 1

Primary CNS tumors

Answer 1

astrocytomas
oligodendrogliomas
ependymomas
others
(meningiomas - tumors of the arachnoid)

Question 2

Most common metastatic tumors of the brain?

Answer 2

1. lung
2. breast
3. melanoma (less common than lung cancers, but more likely to metastasize to the lung)

Question 3

Areas of the brain most commonly involved in CNS/brain tumors?

Answer 3

frontal and parietal lobes

Question 4

Two tumors involving cranial nerves

Answer 4

acoustic neuroma schwannoma)

optic nerve glioma

Question 5

3 types of spinal tumors?

Answer 5

extradural
intradural/extramedullary
intramedullary

Question 6

What is the hallmark of an extradural tumor of the spine?

Answer 6

pain

Question 7

What is an example of an intradural/extramedullary spinal tumor?

Answer 7

meningioma

Question 8

Two examples of intramedullary spinal tumors?

Answer 8

astrocytoma

ependymoma

Question 9

Why is there pain involved with extradural spinal tumors?

Answer 9

mets go to the bone first

Question 10

What is it called when cancer cells go to the meninges?

Answer 10

carcinomatous meningitis

Question 11

What causes acute meningitis?

Answer 11

bacteria

viruses

Question 12

What causes subacute meningitis?

Answer 12

tuberculous

**“kills you in a month”

Question 13

What causes chronic meningitis?

Answer 13

fungus (crypto and coccidiomycosis)

**“Kills you in a year”

Question 14

What are these CSF findings indicative of?

glucose low (even zero)
protein high (up to a gram or more)
WBCs (polys) 100s to 1,000s/cubic mm

Answer 14

bacterial meningitis

Question 15

Why is the glucose low in bacterial meningitis?

Answer 15

inflammation disrupts the transport of glucose across the BBB

Question 16

What are these CSF findings indicative of?

glucose normal (nl >50 mg/dl)
protein ~75-250
WBCs (lymphs) ~50-500

Answer 16

viral meningitis

Question 17

What are these CSF findings indicative of?

glucose low(~10-40) 
protein high (~ 100-300)
WBCs (polys/lymphs) ~100-500

Answer 17

tuberculous meningitis

• *glucose not as low as bacterial meningitis
• *WBCs not as high as in bacterial meningitis

Question 18

What are these CSF findings indicative of?

glucose low (~20-40)
protein high (~50-150)
WBCs (lymphs)  ~25-100

Answer 18

fungal meningitis

Question 19

What does aseptic meningitis refer to?

Answer 19

virally induced

Question 20

Encephalitis is almost always caused by (blank)

Answer 20

viruses

Question 21

Most likely sporadic cause of encephalitis? If it’s epidemic, most likely caused by what?

Answer 21

herpes simplex 1; insect born vector

Question 22

What is a key component in diagnosis of encephalitis?

Answer 22

PCR

Question 23

Is brain imaging useful for encephalitis?

Answer 23

yes! usu focal regions make it easy to detect

Question 24

What causes most cases of brain abscess? What is the most likely cause in AIDS patients?

Answer 24

mixed bacterial flora; toxoplasma gondii

Question 25

How to treat brain abscesses/

Answer 25

antibiotics +/- surgery

Question 26

Most common bacteria involved in a spinal abscess? Most common presenting symptom?

Answer 26

Staph aureus; PAIN

Question 27

How to treat spinal abscess?

Answer 27

neurosurgical emergency; don’t waste time with antibiotic therapy

Question 28

What are these opportunistic infections associated with?

syphilitic meningitis
cryptococcal meningitis
toxo abscess 
CMV myelitis
progressive multifocal encephalopathy (PML)>JC virus

Answer 28

HIV/AIDS

Question 29

HIV-associated (blank) is fairly common

Answer 29

dementia

Question 30

How does a bilateral dumbbell meningioma present? Think of the old neighbor lady…

Answer 30

change in behavior - may be more aggressive/erratic

Question 31

What is pleocytosis anyways?

Answer 31

increased cell count

Question 32

When you think viral encephalitis, what should always be in your differential?

Answer 32

HSV encephalitis