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Y3 - Neuro > Space Occupying Lesions > Flashcards

Space Occupying Lesions Flashcards

1
Q

What are causes of space occupying lesions (SOL)?

A 
Tumours
Haematoma
Aneurysms
Abscess
Granuloma
Cysts
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2
Q

What is the presentation of a SOL?

A

Raised ICP - headache worse in the morning and with coughing or leaning forward, vomiting
Seizures
Progressive focal neurological signs

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3
Q

What neurological signs are caused by a SOL in the frontal lobe?

A 
Weakness
Expressive dysphagia
Loss of smell
Personality change
Loss of motivation
Social disinhibition
Reduced executive functioning
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4
Q

What neurological signs are caused by a SOL in the temporal lobe?

A 
Reduced memory
Reduced hearing
Receptive dysphagia
Emotional disturbance
Odd phenomena - déjà vu
Reduced abstract thinking
Contralateral homonymous hemianopia
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5
Q

What neurological signs are caused by a SOL in the parietal lobe?

A

Sensory loss
Reduced 2 point discrimination
Reduced ability to recognise by touch

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6
Q

What neurological signs are caused by a SOL in the occipital lobe?

A

Contralateral vision loss

Visual disturbance

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7
Q

What neurological signs are caused by a SOL in the cerebellum?

A 
Ataxia
Nystagmus
Slurred speech
Reduced dysdiadokokinesis
Intention tremor/past pointing
Wide based gait
Reduced tone and reflexes
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8
Q

What neurological signs are caused by a SOL in the cerebellopontine angle?

A

Sensorineural hearing loss
Facial weakness
Tinnitus

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9
Q

Where is the SOL likely to be if the patient presents with

memory loss, difficulty understanding language and emotional disturbance?

A

Temporal lobe

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10
Q

Where is the SOL likely to be if the patient presents with slurred speech, wide based gait, intention tremor and reduced tone?

A

Cerebellum

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11
Q

Where is the SOL likely to be if the patient presents with left sided loss of vision?

A

Occipital (right side)

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12
Q

Where is the SOL likely to be if the patient presents with change to their personality, social disinhibition, difficulty with planning and concrete thinking, and difficulty expressing what they want to say.

A

Frontal lobe

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13
Q

Where is the SOL likely to be if the patient presents with loss of sensation and reduced 2 point discrimination?

A

Parietal

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14
Q

Where is the SOL likely to be if the patient presents with sensorineural hearing loss, tinnitus and facial weakness?

A

Cerebellopontine angle

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15
Q

True or false - brain tumours are the 2nd most common cause of cancer related death in <40s and the second most common type of tumour in children

A

They are the 1st (not 2nd) most common cause of cancer related death in <40s
They are the second most common type of tumour in children

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16
Q

What is the presentation of brain tumours?

A

Headache +/- raised ICP symptoms
Progressive focal neurological symptoms (most commonly weakness)
Seizures

17
Q

What are the 5 most common types of primary brain tumour?

A 
Astrocytoma
Oligodendroglioma
Medulloblastoma
Meningioma
Acoustic neuroma
18
Q

What is the most common type of primary brain tumour?

A

Astrocytoma

19
Q

Describe the 4 grades of astrocytoma?

A

Grade 1 - benign, commonly in children and young adults, slow growing, surgery is curative, good prognosis
Grade 2 - largely benign but have small malignant potential, usually in temporal or frontal lobes, average survival 4 years
Grade 3 - anapaestic astrocytoma, survival 2 years
Grade 4 - glioblastoma multiforme, highly invasive, occur from less malignant precursor or de novo, survival less than 1 year

20
Q

What is the most common grade of astrocytoma?

A

Glioblastoma multiform - grade 4

21
Q

What is an oligodendroblastoma?

A

Arise from oligodendrocyte glial cells
Develop in frontal lobe
Commonly invaded into subarachnoid space (toothpaste morphology)
Glow slowly over several decades

22
Q

What age is the peak incidence of oligodendroblstoma?

A

Peak incidence 6-12 then again 25-45

23
Q

How do oligodendrocytes most commonly present?

A

Seizures

24
Q

What is the treatment for oligodendrocytes?

A

Highly chemo-sensitive

25
Q

What are medulloblastomas?

A

Malignant tumours of the cerebellum
Form drop metastases down the spinal cord
Crumbly chalk-like appearance

26
Q

Who generally present with medulloblastomas?

A

Almost exclusively children

27
Q

How do medulloblastomas present?

A

Cerebellar signs

Raised ICP

28
Q

What are meningiomas?

A

Extra-axial tumours of the arachnoid cap cells

Benign or malignant (majority slow growing and benign)

29
Q

What is the presentation of meningiomas?

A

Focal neurological symptoms slowly developing as compression occurs due to growing tumour

30
Q

What is seen on imaging in meningiomas?

A

Skull blistering often present

31
Q

What are acoustic neuromas?

A

Nerve sheath tumour of the vestibulocochlear nerve

Tumour of Schwann cells

32
Q

Where do acoustic neuromas develop?

A

Cerebellopontine angle

33
Q

What are bilateral acoustic neuromas associated with?

A

Neurofibromatosis type 2

34
Q

What is the presentation of acoustic neuromas?

A

Hearing loss
Tinnitus
Balance problems
Associated with facial nerve palsy

35
Q

Are primary or secondary brain tumours more common?

A

Secondary

36
Q

What are the types of tumour that commonly metastasise to the brain?

A 
Lung
Breast
Kidney
Colon
Melanoma
37
Q

What investigation is done for brain tumours?

A

MRI first line
Imaging for metastases (e.g. CXR)
Stereotaxic biopsy via skull burr hole

38
Q

What is the general medical management for brain tumours?

A 
VP shunt for hydrocephalus
Analgesia for headache
Seizure prophylaxis - phenytoin
Acutely raised ICP- mannitol
Prevention of raised ICP - dexamethasone
39
Q

What is the tumour management for brain tumours?

A

Watchful waiting of benign
Surgical removal +/- radiotherapy or chemotherapy
Glioblastomas - temozolamide
Oligodendrogliomas are chemo-sensitive

Y3 - Neuro (14 decks)

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