Rothrock: CNS Tumor Neuropsych Flashcards
Primary CNS tumors
astrocytomas oligodendrogliomas ependymomas others (meningiomas - tumors of the arachnoid)
Most common metastatic tumors of the brain?
- lung
- breast
- melanoma (less common than lung cancers, but more likely to metastasize to the lung)
Areas of the brain most commonly involved in CNS/brain tumors?
frontal and parietal lobes
Two tumors involving cranial nerves
acoustic neuroma schwannoma)
optic nerve glioma
3 types of spinal tumors?
extradural
intradural/extramedullary
intramedullary
What is the hallmark of an extradural tumor of the spine?
pain
What is an example of an intradural/extramedullary spinal tumor?
meningioma
Two examples of intramedullary spinal tumors?
astrocytoma
ependymoma
Why is there pain involved with extradural spinal tumors?
mets go to the bone first
What is it called when cancer cells go to the meninges?
carcinomatous meningitis
What causes acute meningitis?
bacteria
viruses
What causes subacute meningitis?
tuberculous
**“kills you in a month”
What causes chronic meningitis?
fungus (crypto and coccidiomycosis)
**“Kills you in a year”
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
bacterial meningitis
Why is the glucose low in bacterial meningitis?
inflammation disrupts the transport of glucose across the BBB
What are these CSF findings indicative of?
glucose normal (nl >50 mg/dl)
protein ~75-250
WBCs (lymphs) ~50-500
viral meningitis
What are these CSF findings indicative of?
glucose low(~10-40) protein high (~ 100-300) WBCs (polys/lymphs) ~100-500
tuberculous meningitis
- *glucose not as low as bacterial meningitis
- *WBCs not as high as in bacterial meningitis
What are these CSF findings indicative of?
glucose low (~20-40) protein high (~50-150) WBCs (lymphs) ~25-100
fungal meningitis
What does aseptic meningitis refer to?
virally induced
Encephalitis is almost always caused by (blank)
viruses
Most likely sporadic cause of encephalitis? If it’s epidemic, most likely caused by what?
herpes simplex 1; insect born vector
What is a key component in diagnosis of encephalitis?
PCR
Is brain imaging useful for encephalitis?
yes! usu focal regions make it easy to detect
What causes most cases of brain abscess? What is the most likely cause in AIDS patients?
mixed bacterial flora; toxoplasma gondii
How to treat brain abscesses/
antibiotics +/- surgery
Most common bacteria involved in a spinal abscess? Most common presenting symptom?
Staph aureus; PAIN
How to treat spinal abscess?
neurosurgical emergency; don’t waste time with antibiotic therapy
What are these opportunistic infections associated with?
syphilitic meningitis cryptococcal meningitis toxo abscess CMV myelitis progressive multifocal encephalopathy (PML)>JC virus
HIV/AIDS
HIV-associated (blank) is fairly common
dementia
How does a bilateral dumbbell meningioma present? Think of the old neighbor lady…
change in behavior - may be more aggressive/erratic
What is pleocytosis anyways?
increased cell count
When you think viral encephalitis, what should always be in your differential?
HSV encephalitis
