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Neurology > Tumours of Nervous System > Flashcards

Tumours of Nervous System Flashcards

1
Q

primary brain tumours are the 2nd most common tumour in what kind of patient?

A

children

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2
Q

what is the most common cause of cancer death under 40?

A

brain tumours obvs lol

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3
Q

what are general symptoms of brain tumour?

A

neurological deficit
motor weakness
headache
seizures

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4
Q

what name is given to blockage of CSF flow?

A

hydrocephalus

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5
Q

what is consequence of raised ICP?

A

haemorrhage

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6
Q

what are symptoms of raised ICP?

A

headaches
vomiting
mental changes
seizures

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7
Q

what is the characteristics of tumour associated headache?

A

worse in morning - wakes them up

worse on coughing / leaning forward

associated with vomiting

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8
Q

what determines what neurological signs are present?

A

tumour relocation

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9
Q

what does the frontal lobe control?

A

motor

higher cognition - thought, reason, intelligence

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10
Q

what does precentral gyrus in frontal lobe control?

A

movement

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11
Q

what does postcentral gyrus in parietal lobe control?

A

sensation

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12
Q

what does parietal lobe control?

A

sensory

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13
Q

what does temporal lobe control?

A

language
hearing
memory and emotion
association

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14
Q

what does the occipital lobe control?

A

vision

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15
Q

what does cerebellum control?

A

balance

co-ordination

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16
Q

what investigations could take place for a brain tumour?

A 
CT
MRI
LP
PET
lesion biopsy 
EEG
evoked potentials
angiograms 
radionucleotide studies
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17
Q

which cells of neuroepithelial tissue can form tumours?

A 
astrocytes 
oligodendroglial cells 
ependymal cells / choroid plexus 
neuronal cells 
pineal cells 
embryonic
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18
Q

what % of neuroepithelial tissue tumours are astrocytic?

A

60%

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19
Q

what % of astrocytic tumours are high grade?

A

33%

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20
Q

what is a grade I astrocytic tumour?

A

pilocytic astrocytoma
pleomorphic xanthoastrocytoma
subependymal giant cell

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21
Q

what is a grade II astrocytic tumour?

A

low grade astrocytoma

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22
Q

what is a grade III astrocytic tumour?

A

anaplastic astrocytoma

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23
Q

what is a grade IV astrocytic tumour?

A

glioblastoma multiforme

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24
Q

what are the characteristics of a grade I astrocytoma?

A

truly benign

slow growing

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25
Q

who does grade I astrocytomas most commonly occur in?

A

children and young adults

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26
Q

where in the brain do pilocytic astrocytomas usually occur?

A

optic nerve
hypothalamic gliomas
cerebellum
brainstem

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27
Q

what is treatment for grade I astrocytoma?

A

surgery - curative

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28
Q

where in the brain do grade II astrocytomas usually occur?

A

temporal lobe
posterior frontal
anterior parietal

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29
Q

how do those with grade II astrocytomas present?

A

seizures

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30
Q

what are poor prognostic factors for a grade II astrocytoma?

A 
age >50
focal deficit 
short duration of symptoms
raised ICP
altered consciousness 
enhancement on contrast
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31
Q

is a grade II astrocytoma benign?

A

not ultimately since it undergoes differentiation to high grade malignancy (glioblastoma)

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32
Q

what is the treatment of grade II astrocytoma?

A

surgery +/- radiation, chemo or combined

this depends on molecular profile

33
Q

what are the two options of brain surgery?

A

stereotatic vs open

34
Q

what grades of astrocytomas are malignant?

A

III and IV

35
Q

what is the median survival of an anaplastic astrocytoma which can arise de novo?

A

2 years

36
Q

what is the most common primary brain tumour?

A

glioblastoma multiforme (grade IV)

37
Q

what is the median survival of a glioblastoma multiforme?

A

<1 year

38
Q

how does glioblastoma multiforme spread?

A

white matter tracking / CSF pathways

39
Q

what could multiple gliomas be a sign of?

A

neurofibromatosis

tuberous sclerosis

progressive multifocal leukoencephalopathy

40
Q

how are malignant astrocytomas treated?

A

noncurative surgery - survival quality

post operative radiotherapy - external beam radiation

TMZ - chemo drug

41
Q

in what circumstances, is it not safe to drive after brain surgery?

A

if seizure risk (all GBM)

or if left with significant homonymous visual field defect

42
Q

when would you give a low grade astrocytoma radiotherapy?

A

when incomplete removal or malignant degeneration

43
Q

when would you give a benign astrocytoma radiotherapy?

A

only if recurrence / progression not amenable to surgery

44
Q

what are the side effects of radiotherapy?

A

drops IQ by 10
affects skin and hair
tired

45
Q

what new novel therapy could be used for astrocytomas?

A

immunotherapy

46
Q

oligodendroglial tumours make up what % of glial tumours?

A

20

47
Q

what part of the brain do oligodendroglial tumours often occur?

A

frontal lobes

48
Q

in what age does oligodendroglial tumours usually occur?

A

adults 25-45yrs

smaller peak in children 6-12

49
Q

how do oligodendroglial tumours often present?

A

seizures

50
Q

are oligodendroglial tumours mostly low grade or high grade?

A

low grade

with anaplastic / astrocytic component

51
Q

do oligodendroglial tumours have potential to become malignant?

A

yes

52
Q

what are characteristics of oligodendroglial tumours?

A

calcification (usually peripheral)
cysts
peritumoral haemorrhage

53
Q

how are oligodendroglial tumours treated?

A

chemosensitive (procarbazine, lomustine, vincristine)

surgery + chemo (surgery for high grade less convincing)

RT + PCV doubles survival

54
Q

what is the median survival for oligodendroglial tumours?

A

10 years (for low grade)

55
Q

what are main symptoms of brain tumours in adults?

A

headache that wake you +/- vomiting

now neurological deficit, including seizures

56
Q

what are main symptoms of brain tumours in children?

A

tiptoeing
ataxia
vomiting with HA

57
Q

from which cells do meningiomas arise?

A

arachnoid cap cells

58
Q

where in the brain do meningiomas occur?

A

extra axial

parasagittal, convexity, sphenoid and intraventricular

59
Q

meningiomas make up what % of intracranial neoplasms?

A

20

60
Q

how do meningiomas typically present?

A

asymptomatic

otherwise - headache, cranial nerve neuropathies and regional anatomical disturbance

61
Q

what other conditions are associated with meningiomas?

A 
breast cancer 
NF II (22q)
62
Q

what % of meningiomas are histologically benign?

A

90%

63
Q

how can meningiomas be classified?

A

classic
angioblastic
atypical (2%)
malignant (5%)

64
Q

what can induce a meningioma?

A

radiation (eg after childhood leukaemia)

65
Q

what cells are aggressors to meningiomas?

A

clear cell
choroid
rhabdoid
papillary

66
Q

what is seen on CT scan of meningioma?

A

homogenous, densely enhancing
oedema
hyperostosis / skull blistering

67
Q

what is seen on MRI scan of meningioma?

A

dural tail

patency of dural sinuses

68
Q

what is seen on angiography of meningioma?

A

external carotid artery feeders

occlusion of sagittal sinus

69
Q

what is the treatment of meningiomas?

A

small - expectant
preoperative embolisation
surgery
radiotherapy

70
Q

what is the 5 year survival of meningioma?

A

90%

71
Q

what is another name of acoustic neuromas?

A

vestibular schwannomas (of 8th nerve)

72
Q

how do acoustic neuromas typically present?

A

hearing loss
tinnitus
dysequilibrium

73
Q

what can acoustic neuromas begin to cause problems with as they progress?

A

5th, 7th and 8th cranial nerves

brainstem function

hydrocephalus

74
Q

how are acoustic neuromas treated?

A

expectant
hydrocephalus management
radiation
surgery

75
Q

is malignant transformation of acoustic neuroma rare or common?

A

rare

76
Q

how are hearing and balance affected after acoustic neuroma surgery?

A

hearing - decline over several years

vestibular function - worsen substantially in first 6 months and remain stable thereafter

77
Q

what tumour markers must be performed for any midline brain tumour in a child?

A

AFP (yolk sac tumours and teratomas)

beta HCG (choriocarcinoma and germinoma)

LDH (germaninoma and choriocarcinoma and yolk sac)

78
Q

how is hydrocephalus treated?

A

endoscopic third ventriculostomy (ETV) +/- biopsy (also allows CSF collection)

or VP shunt

79
Q

what must you remember and do if patient has HA, vomiting and ataxia?

A

fundoscopy

Neurology (32 decks)

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