Tumors of the CNS

Question 1

Glial tumors

Answer 1

Astrocytoma, ependymoma, oligodendroglioma

Question 2

Nerve tumors

Answer 2

Schwannoma, neurofibroma

Question 3

Metastatic CNS tumors

Answer 3

Breast, lung, melanoma, renal cell carcinoma, and GI cancer

Question 4

Most common primary brain tumors

Answer 4

Glioblastoma multiforme and infiltrative astrocytoma

Question 5

Risk factors for CNS tumors

Answer 5

Ionizing radiation, immunosuppression/chemotherapy, genetic syndromes, EBV infection and CNS lymphoma

Question 6

Li-Faumeni syndrome

Answer 6

Glioma, medulloblastoma, involves TP53 on 17p13

Question 7

Tuberous sclerosis

Answer 7

Subependymal giant cell astrocytoma, cortical tubers, glioma, involves TSC1/2 on 9q34 and 16p13

Question 8

Neurofibromatosis type 1

Answer 8

Glioma (optic nerve), astrocytoma, glioblastoma, involves NF1 on 17q11

Question 9

Neurofibromatosis type 2

Answer 9

Meningioma, schwannoma (bilateral acoustic neuroma), ependymomas, involves NF2 on 22q12

Question 10

Multiple Endocrine Neoplasia type 1

Answer 10

Pituitary, involves Menin on 11q13

Question 11

Retinoblastoma

Answer 11

Retinoblastoma, involves RB1 on 13q14

Question 12

Von Hippel-Lindau disease

Answer 12

Hemangioblastoma, involves VHL on 3p25-20

Question 13

Cerebral perfusion equation

Answer 13

Cerebral perfusion = MAP - ICP

Question 14

Signs and symptoms of CNS tumors

Answer 14

Headache, vomiting, mental status changes, papilledema, seizures, focal neurologic deficits

Question 15

Etiology of signs and symptoms

Answer 15

Invasion of neural/vascular structures, compression of structures, obstruction of CSF flow, herniation, cerebral hypoperfusion

Question 16

Mechanism of brain herniation

Answer 16

Subfalcine herniation of cingulate gyrus, diencephalic downward herniation, classical uncal herniation, upward herniation through tentorium, tonsillar herniation

Question 17

Diagnosis of brain tumors

Answer 17

MRI w/ and w/o contrast is best, definitive Dx through tissue biopsy – except CNS lymphoma – do LP

Question 18

T1 vs T2 MRI

Answer 18

T1 - water, tumor, edema is dark; T2 water, edema, tumor is white (WW2 - water white on T2 MRI)

Question 19

Glioma and Histological Grading

Answer 19

Grade I - slow growing w/ good chance of cure w/ surgical resection; II - can infiltrate, low probability of cure; III - malignant, 2-3 year prognosis, IV - forms new blood vessels, prognosis of months

Question 20

Symptomatic Tx of tumors

Answer 20

Steroids and anticonvulsants

Question 21

1st line treatment for accessible tumors

Answer 21

Surgery

Question 22

Signs and symptoms of pituitary tumors

Answer 22

Headache, endocrine dysfunction, visual field defects, facial numbness

Question 23

Bitemporal hemianopsia in pituitary tumor vs craniopharyngioma

Answer 23

Pituitary tumors leads to loss of upper quadrants and craniopharyngioma starts with inferior quadrants

Question 24

Tx of prolactinoma

Answer 24

Dopamine agonists

Question 25

Acoustic neuroma

Answer 25

Originate from Schwann cells in vestibular portion of CN VIII

Question 26

Symptoms of acoustic neuroma

Answer 26

Hearing loss, tinnitus, headache, dizziness, facial numbness or weakness

Question 27

Other site for schwannomas

Answer 27

Trigeminal nerves and other CNs

Question 28

Tx of primary CNS lymphoma

Answer 28

Steroids (only after biopsy) and methotrexate (crosses BBB)

Question 29

Most common brain neoplasm

Answer 29

Metastasis

Question 30

Signs and symptoms of spinal cord tumors

Answer 30

Pain, weakness, UMN/LMN findings, paresthesias