Tumours of Nervous System Flashcards
primary brain tumours are the 2nd most common tumour in what kind of patient?
children
what is the most common cause of cancer death under 40?
brain tumours obvs lol
what are general symptoms of brain tumour?
neurological deficit
motor weakness
headache
seizures
what name is given to blockage of CSF flow?
hydrocephalus
what is consequence of raised ICP?
haemorrhage
what are symptoms of raised ICP?
headaches
vomiting
mental changes
seizures
what is the characteristics of tumour associated headache?
worse in morning - wakes them up
worse on coughing / leaning forward
associated with vomiting
what determines what neurological signs are present?
tumour relocation
what does the frontal lobe control?
motor
higher cognition - thought, reason, intelligence
what does precentral gyrus in frontal lobe control?
movement
what does postcentral gyrus in parietal lobe control?
sensation
what does parietal lobe control?
sensory
what does temporal lobe control?
language
hearing
memory and emotion
association
what does the occipital lobe control?
vision
what does cerebellum control?
balance
co-ordination
what investigations could take place for a brain tumour?
CT MRI LP PET lesion biopsy EEG evoked potentials angiograms radionucleotide studies
which cells of neuroepithelial tissue can form tumours?
astrocytes oligodendroglial cells ependymal cells / choroid plexus neuronal cells pineal cells embryonic
what % of neuroepithelial tissue tumours are astrocytic?
60%
what % of astrocytic tumours are high grade?
33%
what is a grade I astrocytic tumour?
pilocytic astrocytoma
pleomorphic xanthoastrocytoma
subependymal giant cell
what is a grade II astrocytic tumour?
low grade astrocytoma
what is a grade III astrocytic tumour?
anaplastic astrocytoma
what is a grade IV astrocytic tumour?
glioblastoma multiforme
what are the characteristics of a grade I astrocytoma?
truly benign
slow growing
who does grade I astrocytomas most commonly occur in?
children and young adults
where in the brain do pilocytic astrocytomas usually occur?
optic nerve
hypothalamic gliomas
cerebellum
brainstem
what is treatment for grade I astrocytoma?
surgery - curative
where in the brain do grade II astrocytomas usually occur?
temporal lobe
posterior frontal
anterior parietal
how do those with grade II astrocytomas present?
seizures
what are poor prognostic factors for a grade II astrocytoma?
age >50 focal deficit short duration of symptoms raised ICP altered consciousness enhancement on contrast
is a grade II astrocytoma benign?
not ultimately since it undergoes differentiation to high grade malignancy (glioblastoma)
what is the treatment of grade II astrocytoma?
surgery +/- radiation, chemo or combined
this depends on molecular profile
what are the two options of brain surgery?
stereotatic vs open
what grades of astrocytomas are malignant?
III and IV
what is the median survival of an anaplastic astrocytoma which can arise de novo?
2 years
what is the most common primary brain tumour?
glioblastoma multiforme (grade IV)
what is the median survival of a glioblastoma multiforme?
<1 year
how does glioblastoma multiforme spread?
white matter tracking / CSF pathways
what could multiple gliomas be a sign of?
neurofibromatosis
tuberous sclerosis
progressive multifocal leukoencephalopathy
how are malignant astrocytomas treated?
noncurative surgery - survival quality
post operative radiotherapy - external beam radiation
TMZ - chemo drug
in what circumstances, is it not safe to drive after brain surgery?
if seizure risk (all GBM)
or if left with significant homonymous visual field defect
when would you give a low grade astrocytoma radiotherapy?
when incomplete removal or malignant degeneration
when would you give a benign astrocytoma radiotherapy?
only if recurrence / progression not amenable to surgery
what are the side effects of radiotherapy?
drops IQ by 10
affects skin and hair
tired
what new novel therapy could be used for astrocytomas?
immunotherapy
oligodendroglial tumours make up what % of glial tumours?
20
what part of the brain do oligodendroglial tumours often occur?
frontal lobes
in what age does oligodendroglial tumours usually occur?
adults 25-45yrs
smaller peak in children 6-12
how do oligodendroglial tumours often present?
seizures
are oligodendroglial tumours mostly low grade or high grade?
low grade
with anaplastic / astrocytic component
do oligodendroglial tumours have potential to become malignant?
yes
what are characteristics of oligodendroglial tumours?
calcification (usually peripheral)
cysts
peritumoral haemorrhage
how are oligodendroglial tumours treated?
chemosensitive (procarbazine, lomustine, vincristine)
surgery + chemo (surgery for high grade less convincing)
RT + PCV doubles survival
what is the median survival for oligodendroglial tumours?
10 years (for low grade)
what are main symptoms of brain tumours in adults?
headache that wake you +/- vomiting
now neurological deficit, including seizures
what are main symptoms of brain tumours in children?
tiptoeing
ataxia
vomiting with HA
from which cells do meningiomas arise?
arachnoid cap cells
where in the brain do meningiomas occur?
extra axial
parasagittal, convexity, sphenoid and intraventricular
meningiomas make up what % of intracranial neoplasms?
20
how do meningiomas typically present?
asymptomatic
otherwise - headache, cranial nerve neuropathies and regional anatomical disturbance
what other conditions are associated with meningiomas?
breast cancer NF II (22q)
what % of meningiomas are histologically benign?
90%
how can meningiomas be classified?
classic
angioblastic
atypical (2%)
malignant (5%)
what can induce a meningioma?
radiation (eg after childhood leukaemia)
what cells are aggressors to meningiomas?
clear cell
choroid
rhabdoid
papillary
what is seen on CT scan of meningioma?
homogenous, densely enhancing
oedema
hyperostosis / skull blistering
what is seen on MRI scan of meningioma?
dural tail
patency of dural sinuses
what is seen on angiography of meningioma?
external carotid artery feeders
occlusion of sagittal sinus
what is the treatment of meningiomas?
small - expectant
preoperative embolisation
surgery
radiotherapy
what is the 5 year survival of meningioma?
90%
what is another name of acoustic neuromas?
vestibular schwannomas (of 8th nerve)
how do acoustic neuromas typically present?
hearing loss
tinnitus
dysequilibrium
what can acoustic neuromas begin to cause problems with as they progress?
5th, 7th and 8th cranial nerves
brainstem function
hydrocephalus
how are acoustic neuromas treated?
expectant
hydrocephalus management
radiation
surgery
is malignant transformation of acoustic neuroma rare or common?
rare
how are hearing and balance affected after acoustic neuroma surgery?
hearing - decline over several years
vestibular function - worsen substantially in first 6 months and remain stable thereafter
what tumour markers must be performed for any midline brain tumour in a child?
AFP (yolk sac tumours and teratomas)
beta HCG (choriocarcinoma and germinoma)
LDH (germaninoma and choriocarcinoma and yolk sac)
how is hydrocephalus treated?
endoscopic third ventriculostomy (ETV) +/- biopsy (also allows CSF collection)
or VP shunt
what must you remember and do if patient has HA, vomiting and ataxia?
fundoscopy
