Tumors and Infections Flashcards
primary vs secondary tumors
primary - from the CNS
secondary - metastatic
what are the most common cancer types in children?
brain and CNS tumors
(2nd most frequent cause of death)
are most CNS tumors primary or secondary?
secondary - metastases
what CNS tumors are seen in adults?
megingioma
gliobastoma
70% of tumors in children are located where?
posterior fossa
70% of tumors in adults are located where?
cerebral hemispheres
sx of tumor in posterior fossa
ataxia, HA, increased ICP, CN sx
generalized CNS tumor sx are related to
increased ICP
sx of frontal lobe tumors (31%)
clinically silent
personality changes
non-fluent aphasia (dominant)
urinary frequency & urgency
seizures
hemiparesis
sx of temporal lobe tumors (32%)
seizures
memory disturbance
superior quadrantanopia
fluent aphasia (dominant)
sx of temporoparietal lobe tumors (7%)
fluent aphasia (dominant)
or conduction
sx of occipital parietal lobe tumors (5%)
homonymous hemianopsia
visual seizures
visual agnosias
sx of frontoparietal lobe tumors (11%)
hemiparesis
hemisensory loss
non-fluent aphasia (dominant)
sx of parietal lobe tumors (10%)
hemisensory loss
non-fluent aphasia (dominant)
hemineglect (nondominant)
anosognosia (nondominant)
hemiparesis
homonymous hemianopsia or visual neglect
sx of increased ICP
HA
nausea
papilledema (MD look at fundus)
how do increased ICP HAs present?
dull
worse in AM
worse with bending over
seen in 50% of pts with brain tumors
what is the Monro-Kellie doctrine?
sum of volume of CSF, blood, and brain is constant in enclosed hard skull
what structure plays a key role in herniation syndromes?
dural septa
which artery is compressed with cingulate herniations?
ACA
what structures are affect in uncal herniation?
hippocampus and uncus
pushed down
sx of uncal herniation
ipsilateral fixed and dilated pupil (CN III)
impaired consciousness
hemiparesis
PCA infarcts
sx of uncal herniations are due to pressure on
tentorial notch
what is compressed with tonsilar herniations?
4th ventricle
medulla
sx of tonsilar herniation
stiff neck
progresses to decerebrate posture and coma
what is the optimal diagnostic tool to use for CNS tumors?
MRI w/wo contrast
which spinal tumors arise from primitive cells?
medulloblastomas
list glioma classification in order form best to worst prognosis
1) pilocytic astrocytoma
2) low grade astrocytoma
3) anaplastic astrocytoma
4) glioblastoma
astrocytomas usually present with (sx)
HA and seizures
favorable prognosis factors for astrocytoma
younger age
seizure as only sx
smaller tumor size
sx of glioblastoma
focal signs
cognitive changes
increased ICP
what meds can be given to reduced ICP?
steroids
(dexamethasone, mannitol)
T/F: glioblastomas usually always return
T
what can indicate the tumor is back for glioblastomas?
new seizure
how can medulloblastoma cause hydrocephalus?
block the 4th ventricle
what population is medulloblastoma seen in?
children
____ metastases have a worse prognosis for medulloblastoma
extracranial
what is the most common primary brain tumor?
meningiomas
meningiomas arise from ____ cells
arachnoid
are meningiomas benign or malignant?
benign
what are primary sites that metastasize to the CNS?
lung (50%)
breast (15%)
melanoma (10%)
GI, prostate, ovary (10%)
what radiologic marker is a sign of metastatic disease?
multiple masses at gray/white junction
sx of spinal mets
back pain
tenderness
B paraparesis
incontinence
list the spinal levels in order of most likely to have mets to least
thoracic
lumbar
cervical
what factor plays a significant role in prognosis for spinal metastatic disease?
ambulation
(not = bad)
what structures are involved with leptomeningeal mets (SC)?
basal cisterns
cauda equina
what type of disorder is polymyositis and dermatomyositis?
paraneoplastic disordes
meningitis sx
fever, chills
HA
neck pain
generalized convulsions
drowsiness/confusion
infants: fontanels buldging, vomiting, irritability
what test look for signs of meningeal issues?
Kernig’s sign (flex hip to 90 then extend knee)
Brudzinski’s sign (flex neck –> hip and knee flexion)
are arteries or veins more effected by bacterial meningitis?
veins
how does CSF change in bacterial meningitis?
increased pressure
increased WBC
increased protein
decreased glucose
bacteria on gram stain
ideally a treatment should be started within _____ of suspecting meningitis
6 hours
T/F: acute meningitis is a medical emergency
T!!!
meds for bacterial meningitis
antibiotics
steroids
which neuro disease’s meds puts pts at risk for meningococcal meningitis?
myasthenia gravis
what is a telling sx of meningococcal meningitis?
rash
what is a common cause of viral meningitis?
enterovirus (most common)
Herpes Simplex virus
sx of acute encephalitis
fever
impaired consciousness
seizures
hemiparesis
ataxia
CN palsies
what viruses cause acute encephalitis?
enterovirus
arbovirus
what is the most serious encephalitis?
herpes simplex virus encephalitis
which type of herpes is usually the cause of herpes simplex virus encephalitis?
type 1
what lobes are mainly effected by herpes simplex virus encephalitis?
temporal and frontal
med to treat herpes simplex virus encephalitis
IV Acyclovir
sx of TB meningitis
gradual onset
CN palsies
hydrocephalus
stroke
subdural empyema usually arises from
diseases of the sinuses or middle ear
which veins are affected in subdural emphysema?
meningeal
sx of subdural empyema
generalized HA
fever
focal seizures
hemiparesis
hemisensory loss
brain abscess occurs when there is ____ of brain tissue along with _____ infection
necrosis
bacterial
tx for brain abscess
aspiration
broad-spectrum antibiotics
early meningitis occurs _____ after infection
6-12 months
meningovascular syphilis occurs _____ after primary infection
5-12 years
initial sx of Lyme disease
fever
HA
fatigue
rash (erythema migrans)
later (weeks to months) sx of Lyme disease
meningitis
CN palsies (Bell’s - CN 7)
radiculopathy
neuropathy
cardiac disease
which type of infection in more common bacterial or fungal?
bacterial
what is the most common fungal infection in the US?
cryptococcosis
which fungal infection is common with DM?
mucormycosis
(can cause stroke)
shingles sx
radicular pain
vesicular eruption in DERMATOMAL PATTERN
a PNS sx of COVID is
Guillon Barre
sx of prion disease
rapid progression
fatal w/i 1 year
what is Creutzfeldt-Jacob disease
prion disease
rapidly progressive dementia, behavioral changes, ataxia, myoclonic jerks, blindness
T/F: HIV/AIDs can affect the NS at ANY level
T
opportunistic infection predominant as ____ count drops in HIV/AIDs
CD4
most mass lesions of the brain in AIDs are _____ or ______
toxoplasmosis
primary CNS lymphoma
(99% get feet numbness)
what is the #1 cause of seizures globally?
neurocysticercosis
what is neurocysticercosis?
parasite from undercooked pork
