SOLs Flashcards
aetiology of SOLs
1ry tumour
2ry tumour
vascular
infection
granuloma
examples of 1ry [intracranial tumours]
gliomas
meningiomas
1ry CNS lymphoma
cerebellar haemangioblastoma
pituitary tumour
nerve sheath tumours
define glioma
malignant, intrinsic brain tumours originating from astrocytes and oligodendrocytes – typically occur in the cerebral hemisphere à rarely metastasise – spread by extension
types of gliomas
· Astrocytoma:
- common 1O tumour
- Origin: astrocytes
· Oligodendroglioma:
- Origin: oligodendrocytes
- Development: slow-growing – tumours may become calcified
· Glioblastomamultiforme:
- Highly malignant tumour - no cell differentiation
- Prognosis: poor - life expectancy 1yr
· Ependymoma:
- Origin: ependymal cells and choroid plexus – occur in the ventricles (4th) or S.C. (cervical spine/conus medullaris à spread via cerebrospinal pathways and infiltrate surrounding tissue
meningioma [epidemiology, origin, development, location]
· Epidemiology: F>M 2:1
· Benign tumours
· Origin: arachnoid membrane and granulations
· Development: grows large over many years
· Location: common sites are parasagittal, olfactory groove, tuberculumsellae and sphenoidal wing
1ry CNS lymphoma [define, epidemiology, aetiology, location]
· Definition: B-cell non-hodgkin’s lymphoma
· Epidemiology: rare – 5% of brain tumours, M>F >60yr
· Aetiology: immunosuppressed patients in HIV
· Location: brain, S.C., leptomeninges
cerebellar haemangioblastoma [origin/associations]
· Origin: blood vessels
· Associations: von Hippel–Lindau disease
pituitary tumour [pathology, clinical features]
· Pathology: endocrine dysfunction
· Clinical features: chiasmal compression = bi-temporal hemianopia
tyoes of nerve sheath tumours?
Neurofibromas - Origin: Schwann cells
· Schwannomas – Origin: non-myelinating Schwann cells and other cells in the peripheral nerves such as fibroblasts
from where do 2ry intracranial tumours originate
: metastatic carcinoma - breast, lung, melanoma (30% - common in elderly
vascular causes of intracranial tumours
chronic subdural haematoma, AVM, aneurysm
how does infection cause intracranial tumour
abscess, cyst (cysticercosis – parasite Taeniasolium)
which granulmatous disease cause intracranial tumours
TB, sarcoid
s/s of SOL
- ↑ ICP
- Headache: worse on waking, lying down, bending forward, coughing, straining.
- Vomiting
- Papilloedema
- ↓GCS
- Seizures
- Exclude SOL in adult-onset seizures, especially w/ localising aura or post-ictal weakness (Todd’s)
- Subtle Personality Changes
- Evolving Focal Neurology
- May cause false-localising signs: CN6 palsy
- Localising features:
Frontal lobe:
- Motor function: Hemiparesis
- Acceptable social behaviour: personality change (indecent, ↓ activity, indiscreet)
- Speech: Broca’s dysphagia, ↓ verbal function
- Unilateral anosmia: loss of smell
- Cognition and memory: lack of drive, concrete thinking, perseveration
- Executive dysfunction: unable to plan tasks
Temporal lobe:
- Vision: contralateral homonymous hemianopia (quadrantanopia – Meyers loop affected)
- Receptive Dysphasia: Wernicke’s
- Memory: Amnesia
Parietal lobe:
- Sensory: hemisensory loss, ↓ 2-point discrimination, Astereognosis (unable to recognise objects), sensory inattention, dysphasia
Occipital lobe:
- Vision: contralateral visual field deficit
Cerebellum:
- DASHING:
§ Dysdiadochokinesis
§ Dysmetria: past pointing
§ Ataxia: limb/truncal
§ Slurred speech:dysarthria
§ Hypotonia
§ Intension tremor
§ Nystagmus: horizontal = ipsilateral hemisphere
§ Gait abnormality
Cerebellopontine angle:
- Motor function: Hemiparesis
Midbrain: pineal tumours or midbrain infarcts
- Eyes: up or down gaze
- Pupil response: to light/near
- Nystagmus
Corpus callosum:
- loss of communication btw lobes: left hand unable to carry to verbal commands
ix
- Imaging: CT or MRI (better for post. cranial fossa)± consider biopsy
LP: avoid before imaging – risk of conning
