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NEUROLOGY > Tumors of the CNS > Flashcards

Tumors of the CNS Flashcards

1
Q

How do tumors of the CNS usually present as?

A
  • PROGRESSIVE neurological deficit (68%)
  • HEADACHE (54%)
  • motor weakness
  • Seizures
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2
Q

What is an eventual consequence of raised ICP?

A
  • Mass in skull (rigid closed box) may BLOCK csf flow ==> HYDROCEPHALUS
  • Hemorrhage
    (vomiting/mental changes/ seizures)
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3
Q

Swollen brain may _______

A

herniate (uncal/tonsillar/subfalcine/central herniation)

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4
Q

Why may headache arise from a tumor?

A
  • raised ICP
  • compression of DURA, blood vessels, periosteum
  • 2ry to DIPLOPIA (II,IV,VI; INO)
  • 2ry to diff. focusing
  • extreme hypertension (CUshing’s Triad)
  • psychogenic
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5
Q

Tumor in the temporal lobe may result in ?

A
  • alterations in behaviour
  • memory
  • hearing
  • vision
  • emotion
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6
Q

Left hemisphere of the brain is responsible for?

A
  • speech, MOTOR, sensory fxn
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7
Q

What concepts is the right hemisphere resp. for?

A
  • abstract concepts
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8
Q

How may raised ICP trigger Cushing’s triad?

A
  • raised ICP may reduce cerebral blood flow
  • CUSHING’s triad is in response to overcome the raised ICP
  • incl. Hypertension/ bradycardia/ bradypnoea
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9
Q

What are glial tumors?

How are the Astrocytic tumors graded?

A

Tumors that arise from astrocytes or oligodendrocytes

  • 3-tier system of astrocytic tumors :
    1. Astrocytomas
  1. Anaplastic astrocytoma
  2. Glioblastoma Multiforme
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10
Q

Tumor grading is based on 4 fts. What are they?

A
  1. endothelial proliferation
  2. cellular PLEOMORPHISM
  3. MITOSES
  4. presence of NECROSIS
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11
Q

Can low grade astrocytic tumors become aggressive?

A
  • YES

- they grow slowly but hve the propensity to become malignant over time

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12
Q

So best way to treat a glioma?

A
  • SURGICAL RESECTION!

Curative

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13
Q

Name a grade 1 astrocytoma and who are victim to it?

A
  • PILOCYTIC Astrocytoma

- —seen in children and young adults

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14
Q

Where may the pilocytic astrocytoma be found?

A
  • optic nerve
  • cerebellum
  • hypothalamus
  • brainstem
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15
Q

WHere do low grade astrocytomas form?

A
  • temporal lobe
  • posterior frontal
  • anterior parietal
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16
Q

What are the poor prognostic factors for low grade astrocytomas?

A
  • > 50y.o
  • focal deficit
  • SHORT duration of symtpoms
  • raised ICP
  • ALTERED CONSCIOUS
  • enhancement on CT
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17
Q

Name a grade II astrocytoma.

A

Fibrillary Astrocytoma

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18
Q

How is fibrillary astrocytoma treated?

A
  • surgically +/- radiation/ chemo/ combinat.
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19
Q

What are the poor prognosis factors in Gr. II astrocytoma?

A
  • > 45y.o
  • large tumor (>6cm)
  • incomplete resection
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20
Q

Name a gr.III astrocytoma and its median survival?

A
  • Anaplastic astrocytoma

- ~2 years

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21
Q

What grade is Glioblastoma Multiforme? What is the median survival rate?

A
  • GR.IV
  • most common PRIMARY tumor
  • — <1yr
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22
Q

How does the glioblastoma multiforme spread?

A
  • via WHITE matter

- CSF pathways

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23
Q

Since a surgical resection (alone) of the glioblastoma multiforme is not as effective; how is the high grade astrocytoma managed?

A

STUPP protocol

  • surgical resection
  • radiotherapy
  • temozolomide (adjuvant therapy)
  • —improves survival to 14 months
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24
Q

Role of DVLA for a pt just recived brain surgery? -

A
  • PT TO INFORM DVLA of driving (not safe post-op d.t seizure risk)
  • OR if left with significant homonynous visual field defect
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25
Q

What forms of chemo is available?

A
  • Temozolomide
  • PCV (procarbazine/ CCNU- Lomustine/ Vincristine)
  • carmustine wafers
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26
Q

How effective is radiotherapy?

A
  1. MALIGNANT degeneration in LOW grade astrocytomas with or without surgery or done if incomplete resection was performed
    - given to BENIGN astrocytomas if recurrence is NOT amenable to surgery
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27
Q

What are the S.E of RT?

A
  • drops IQ by 10
  • skin and hair loss
  • tired
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28
Q

Explain in 3 steps how immunotherapy works.

A
  • tumor tissue is harvested FTER SURGERY (made separate into Ag)
  • in lab dish Ags are mixed with dendritic cells
  • mixture injected into pts skin
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29
Q

60% of glial tumors are Astrocytomas.

What is the 20% of glial tumors?

A
  • Oligodendroglial tumors
30
Q

Where are (and in whom) Oligodendroglial tumors usually found in?

Its primary presentation?

A

frontal lobes
- adults 25-45 y.o

  • Seizures
31
Q

How to distinguish oligodendrogial tumors from astrocytomas?

A
  • cysts
  • peritumoral hemorrhage
  • calcification (peripheral)
32
Q

What is the grading of oligodendroglial tumors?

A
  • LOW gr.

- anaplastic/astrocytic component

33
Q

How to rx oligodendrogliomas?

A
  • chemosensitive: PCV/Lomustine/ Vincristine
  • Surgery+ Chemo
  • to decr. seizures: RT
  • –RT+ PCV doubles survival
34
Q

Median survival low gr. oligodendroglioma?

A

10 yrs

35
Q

What are red flags for brain tumors?

A
  1. headaches that WAKE you up +/- vomiting
  2. new neuro deficits
  3. seizures
  4. tiptoeing, ataxia
  5. vomiting with HA in kids
36
Q

What support should the pt be made aware of>

A
  • Macmillan nursing

- family support

37
Q

What are the symptoms of meningiomas?

A
  • usually asymptomatic
  • headaches
  • at skull base? = CN neuropathies
  • regional anatomical disturbance
38
Q

Where are meningiomas found?

A
  • parasagittal
  • convexity
  • sphenoid
  • intraventricular
39
Q

What are the diff types of meningiomas>

A
  • classic
  • angioblastic
  • atypical (2%)
  • malignant (5%)
40
Q

What are the aggressive types of meningiomas?

A
  • clear cell
  • choroid
  • rhabdoid
  • papillary
  • radiation induced meningiomas (hx of childhood leukemia/ in MIDLINE)
41
Q

What is seen on CT for meningiomas?

A
  • homogenous (densely enhancing)
  • EDEMA
  • hyperostosis/ skull blistering (thickening of skull)
42
Q

What is seen on MRI meningiomas?

A
  • DURAL tail (d.t attachment of meningioma to dura)

- patency of dural sinuses

43
Q

What additional vascular investigation is performed for meningiomas?

A
  • angiography +/- embolisation

EXT. carotid feeders/ sagittal sinus occlusion

44
Q

What is the treatment of meningiomas?

A
  • pre-operative embolisation
  • surgery
  • rt
  • 5yr survival for 90%
45
Q

Name nerve sheath tumors.

A
  • schwannomas
  • neurofibromas
  • malignant peripheral nerve sheath tumors (1%)
46
Q

What is a vestibular sschwannomas? And its symptoms?

A
  • acoustic neuroma arising from CN 8
    > hearing LOSS
    > Tinnitus
    > dysequilibrium
47
Q

What nerves can also be grossly affected by the acoustic neuromas?

A

CNs 5, 7, 8

—consequently leading to brainstem fxn and hydrocephalus

48
Q

How to rx acoustic neuroma?

A
  • audiometry/audiologic
    (radiographic evaluation)

——hydrocephalus management+ RT+ surgery
—–50% managed surgically (rapid loss of hearing w/ or w/o surgery)
25% managed medically (periodic neuro exam, hearing aid, periodic MRI)

49
Q

If the AN is <3cm big, what is usually done to manage it?

How effective is it?

A
  • GAMMA knife procedure (doesn’t require the opening of the skull)
  • hearing still declines over SEVRAL years
  • vestibular fxn worsens a lot in first 6 months, then stabilizes
50
Q

Risk of AN ?

A

rare for malignant transformation
- but decline in hearing is inevitable
(slower with Gamma Knife)

75% increase in SIZE over 2 years

51
Q

Post-op complications of Acoustic neuromas?

A
  • facial nerve palsy
  • loss of corneal reflex
  • nystagmus
  • abnormal eye movements
52
Q

Where are intracranial germ cell tumors usually found?

A

Pineal gland and pituitary gland

53
Q

What are the general fts of Germ cell tumors?

A

90% affect those YOUNGER than 20 y.o

- Males

54
Q

Medium through which GC tumors metastasize?

A
  • via CSF
55
Q

Most common CNS GC tumor?

A

GERMINOMAS

radiosensitive

56
Q

Best CT imaging in which GC tumors are best visible?

A

ISO- or HYPERdense

57
Q

What are the 2 chemical substances GC tumors produce and can be used as a tumor marker?

A

AFP
Beta-HCG
LDH

(check with ANY MIDLINE tumor in child)

58
Q

Name non-germinomatous tumors.

A
  • teratoma
  • yolk sac tumor
    choriocarcinoma
    embyronal carcinoma
    ——all of which are LESS radiosensitive
59
Q

Which GC tumor is produces AFP?

A

yolk sac tumors

and teratomas

60
Q

Which GC tumor produces b-hcg?

A

Choriocarcinoma

61
Q

Which GC tumor produces Placental alkaline phosphatase?

A

germinomas
choriocarcinoma
yolk sac

62
Q

What helps treat hydrocephalus?

A

Endoscopic third ventriculostomy (ETV +/- biopsy()

Ventriculoperitoneal shunt

63
Q

What does pituitary tumors cause?

A
  • bitemporal hemianopia
  • HA
  • endocirne abnormality
  • Cushing’s
  • Acromegaly
64
Q

What to expect post-op of pituitary tumors?

A

HYPOPITUITARISM:

  • pallor, yellowish tinge skin (reduced MSH)
  • fine wrinkling of skin
  • absent of AXILLARY hair
  • puffy face and hypomimia
  • ——GH is lost first; FHS and LH next (amenorrhea); then TSH, ACTH and PROLACTIN
  • —-diabetes insipidus is COMMON post-op
65
Q

How to identify the tumor is a GLIOBLASTOMA?

A 
- expresses GFAP 
.
.
.
- Seen in those >65y.o
66
Q

How does a Glioblastoma classically appear on CT?

A

crosses the corpus callosum

repping a buterfly on CT

67
Q

Prior exposure to radiation to the head, predisposes the patient to what exactly?

A
  • MENINGIOMA
68
Q

Parasagittal meningioma presents as?

A
  • ACA stroke

- hemiparesis (Lower limb)

69
Q

Purpose of angigraphy +/- embolisation before surgical resection of meningioma?

A
  • meningiomas are usually quite VASCULAR

- angiography allows us to identify if it is a hypervascular tumor

70
Q

Which brain tumor is said to be estrogen AND progesterone sensitive and often ARISES from the background of pregnancy?

A

MENINGIOMAS

71
Q

Pituitary tumors may result in excessive release of various hormones. What risk does this hold?

A
  1. GH and IGF-1= ACROMEGALY and death from HOCM

2. Cortisol excess also FATA;

NEUROLOGY (36 decks)

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