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Radiation Therapy in Practice > Tumours of the CNS I > Flashcards

Tumours of the CNS I Flashcards

1
Q

How do frontal lobe tumours present

A
  • loss of short term memory
  • lack of foresight
  • distractibility
  • Dorsolateral tumours (to the back and side of the frontal lobe): hypokinesia and apathy
  • orbitofrontal tumours: hyperkinesia, increased instinctual behaviour
  • Broca’s area: Expressive aphasia (can comprehend but not fluent)
  • Wernickes’ area: Receptive aphasia (fluent but cannot comprehend)
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2
Q

frontal lobe right hemisphere responsible for

A

holistic and musical

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3
Q

frontal lobe left hemisphere responsible for

A

analytical, information processing

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4
Q

temporal lobe tumour presentation

A
  • high level auditory
  • language comprehension and verbal memory
  • high level visual processing of complex stimuli
  • location of tumour determines presenting signs and symptoms
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5
Q

occipital lobe tumour presentation

A
  • visual processing centre
  • visual hallucinations (seeing bright/flashing/floaters in front of the eye)
  • visual defects (hemianopia - able to see only half of their eyes vertically or horizontally)
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6
Q

what does the brainstem consist of

A

midbrain, pons and medulla oblongata

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7
Q

what does the brainstem connect

A

the diencephalon to the hindbrain

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8
Q

CN I

A

Olfactory Nerve
“Oh Oh Oh To Touch And Feel Very Good Ah Heaven”
Olfactory, Optic, Oculomotor, Trochlear, Trigeminal, Abducens, Facial, Vestibulocochlear, Glossopharyngeal, Vagus, Accessory, Hypoglossal
“Some Say Money Matters But My Brother Says Big Books Matter More”
Sensor, sensory, motor, motor, both, motor, both, sensory, both, both, motor, motor

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9
Q

CN II

A

Optic Nerve
“Oh Oh Oh To Touch And Feel Very Good Ah Heaven”
Olfactory, Optic, Oculomotor, Trochlear, Trigeminal, Abducens, Facial, Vestibulocochlear, Glossopharyngeal, Vagus, Accessory, Hypoglossal
“Some Say Money Matters But My Brother Says Big Books Matter More”
Sensor, sensory, motor, motor, both, motor, both, sensory, both, both, motor, motor

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10
Q

CN III

A

Oculomotor nerve
“Oh Oh Oh To Touch And Feel Very Good Ah Heaven”
Olfactory, Optic, Oculomotor, Trochlear, Trigeminal, Abducens, Facial, Vestibulocochlear, Glossopharyngeal, Vagus, Accessory, Hypoglossal
“Some Say Money Matters But My Brother Says Big Books Matter More”
Sensor, sensory, motor, motor, both, motor, both, sensory, both, both, motor, motor

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11
Q

CN IV

A

Trochlear nerve
“Oh Oh Oh To Touch And Feel Very Good Ah Heaven”
Olfactory, Optic, Oculomotor, Trochlear, Trigeminal, Abducens, Facial, Vestibulocochlear, Glossopharyngeal, Vagus, Accessory, Hypoglossal
“Some Say Money Matters But My Brother Says Big Books Matter More”
Sensor, sensory, motor, motor, both, motor, both, sensory, both, both, motor, motor

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12
Q

CN V

A

Trigeminal Nerve
“Oh Oh Oh To Touch And Feel Very Good Ah Heaven”
Olfactory, Optic, Oculomotor, Trochlear, Trigeminal, Abducens, Facial, Vestibulocochlear, Glossopharyngeal, Vagus, Accessory, Hypoglossal
“Some Say Money Matters But My Brother Says Big Books Matter More”
Sensor, sensory, motor, motor, both, motor, both, sensory, both, both, motor, motor

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13
Q

CN VI

A

Abducens nerve

“Oh Oh Oh To Touch And Feel Very Good Ah Heaven”
Olfactory, Optic, Oculomotor, Trochlear, Trigeminal, Abducens, Facial, Vestibulocochlear, Glossopharyngeal, Vagus, Accessory, Hypoglossal
“Some Say Money Matters But My Brother Says Big Books Matter More”
Sensor, sensory, motor, motor, both, motor, both, sensory, both, both, motor, motor

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14
Q

CN VII

A

Facial nerve

“Oh Oh Oh To Touch And Feel Very Good Ah Heaven”
Olfactory, Optic, Oculomotor, Trochlear, Trigeminal, Abducens, Facial, Vestibulocochlear, Glossopharyngeal, Vagus, Accessory, Hypoglossal
“Some Say Money Matters But My Brother Says Big Books Matter More”
Sensor, sensory, motor, motor, both, motor, both, sensory, both, both, motor, motor

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15
Q

CN VIII

A

Vestibulocochlear nerve

“Oh Oh Oh To Touch And Feel Very Good Ah Heaven”
Olfactory, Optic, Oculomotor, Trochlear, Trigeminal, Abducens, Facial, Vestibulocochlear, Glossopharyngeal, Vagus, Accessory, Hypoglossal
“Some Say Money Matters But My Brother Says Big Books Matter More”
Sensor, sensory, motor, motor, both, motor, both, sensory, both, both, motor, motor

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16
Q

CN IX

A

Glossopharyngeal nerve

“Oh Oh Oh To Touch And Feel Very Good Ah Heaven”
Olfactory, Optic, Oculomotor, Trochlear, Trigeminal, Abducens, Facial, Vestibulocochlear, Glossopharyngeal, Vagus, Accessory, Hypoglossal
“Some Say Money Matters But My Brother Says Big Books Matter More”
Sensor, sensory, motor, motor, both, motor, both, sensory, both, both, motor, motor

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17
Q

CN X

A

Vagus nerve

“Oh Oh Oh To Touch And Feel Very Good Ah Heaven”
Olfactory, Optic, Oculomotor, Trochlear, Trigeminal, Abducens, Facial, Vestibulocochlear, Glossopharyngeal, Vagus, Accessory, Hypoglossal
“Some Say Money Matters But My Brother Says Big Books Matter More”
Sensor, sensory, motor, motor, both, motor, both, sensory, both, both, motor, motor

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18
Q

CN XI

A

Accessory nerve

“Oh Oh Oh To Touch And Feel Very Good Ah Heaven”
Olfactory, Optic, Oculomotor, Trochlear, Trigeminal, Abducens, Facial, Vestibulocochlear, Glossopharyngeal, Vagus, Accessory, Hypoglossal
“Some Say Money Matters But My Brother Says Big Books Matter More”
Sensor, sensory, motor, motor, both, motor, both, sensory, both, both, motor, motor

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19
Q

CN XII

A

Hypoglossal nerve

“Oh Oh Oh To Touch And Feel Very Good Ah Heaven”
Olfactory, Optic, Oculomotor, Trochlear, Trigeminal, Abducens, Facial, Vestibulocochlear, Glossopharyngeal, Vagus, Accessory, Hypoglossal
“Some Say Money Matters But My Brother Says Big Books Matter More”
Sensor, sensory, motor, motor, both, motor, both, sensory, both, both, motor, motor

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20
Q

what cranial nerves arise from midbrain

A

CN III, CN IV and optic tracts in midbrain at junction with diencephalon

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21
Q

what cranial nerves arise in the pons

A

CN V, CN VI, CN VII, CN VIII

22
Q

what cranial nerves arise in medulla oblongata

A

CN XII, CN IX, CN X, CN XIc and CN XIs

23
Q

three functional parts of cerebellum

A

vestibulocerebellum, spinocerebellum and neocerebellum

24
Q

vestibulocerbellum affected by midline tumours causes what

A

nystagmus (scanning motion of the eye) and truncal ataxia (falling to the side from the trunk)

*medulloblastoma arise in vestibulocerbellum

25
Q

what does spinocerebeullum control & what do tumour of this area cause

A

spinocerebeullum controls posture and gait
ataxia of stance and gait

26
Q

what does neocerebeullum control & what do lesions in this area result in

A

neocerebellum controls coordination
lesions result in ipsilateral incoordination, faulty phonation and articulation

27
Q

anatomy of meninges from outer to inner

A

dura matter, arachnoid matter, subarachnoid space, pia matter

28
Q

two great dural folds

A

falx cerebri and tentorium cerebelli

29
Q

supratentorial compartment

A

forebrain
frontal, parietal, temporal lobes

30
Q

infratentorial compartment

A

hindbrain
mainly cerebellum but sometimes pons

31
Q

how many pairs of spinal nerves are attached to the spine

A

31 pairs
8 cervical, 12 thoracic, 5 lumbar, 5 sacral, 1 coccygeal

32
Q

where is lumbar cistern

A

from L1/L2 to S2, but can vary
lumbar cistern is an area that gathers fluid. important when treating medulloblastoma
we need an MRI to decipher where lumbar cistern is

33
Q

what is the order of the pathways in the spine

A

propriospinal pathways innermost
motor pathways intermediate
sensory pathways outermost

34
Q

what are neuroglia cells & what is their function

A

the connective tissue of CNS
nutritive and supportive functions

35
Q

what are the four types of neuroglial cells

A

astrocytes
oligodendrocytes
microglia
ependymal cells

36
Q

what do astrocytes do

A
  • rigid cells, support brain
  • mop up K+ ions and other neurotransmitters
  • phagocytose decaying synaptic boutons
  • can multiply at any time
  • spontaneous local proliferation may give rise to astrocytoma
37
Q

what do oligodendrocytes do

A
  • wrap myelin sheaths around axons in CNS
  • known as satellite cells in PNS
  • satellite cells take part in ion exchange with neurons
38
Q

what do microglia do

A
  • main phagocytes of CNS
  • most line areas near blood-brain barrier
39
Q

what do ependymal cells do

A
  • line the ventricular system of the brain
  • cilia are present on the free surface of ependymal cells
  • cilia help to circulate CSF through the ventricles
40
Q

aetiology and risk factors - environmental factors

A
  • prior ionising radiation: associated with new meningiomas, gliomas and sarcomas
  • ? food containing N-nitroso compounds (smoked foods)
  • ? synthetic rubber manufacturing (making tyres etc)
  • ? polycyclic hydrocarbons
  • ? history of head trauma/seizures, epilepsy
41
Q

aetiology and risk factors - genetic factors
(be aware but not needed to learn off)

A

5% of pts with malignant gliomas have a family history that may be related to rare hereditary syndromes
- neurofibromatosis (NF1) syndrome - peripheral nerve sheath neurofibromas, optic and intracranial gliomas
- NF2 syndrome -bilateral acoustic neuromas, gliomas, ependymomas and meningiomas
- Turcots’ syndrome - primary brain tumours with colorectal cancer
- Lifraumeni syndrome - breast cancer, sarcoma and brain tumour
- retinoblastoma - Rb tumour suppressor gene, chromosome 13

42
Q

natural history and spread
direct infiltration

A
  • main method of spread
  • all tumour of CNS enlarge through infiltration and/or compression of neural tissue
  • increased peritumoural oedema leads to intra-cranial pressure
  • local infiltration leads to neurologic signs
  • crossing of corpus callosum invading contralateral hemisphere
43
Q

natural history and spread
tumours prone to seeding

A
  • medulloblastoma, ependymoma, pineoblastoma, germ cell tumours, lymphoma
  • meningeal deposits - foramen magnum to S4
  • ventriculoperitoneal shunt may lead to peritoneal seeding
    if there is raised ICP that cannot be lessened with steroids, the pt will need shunt placement. VP shunt is placed in the ventricles.
44
Q

clinical presentation CNS tumours
general symptoms **favourite SQ)

A
  • epilepsy/seizures
    generalised / focal
  • raised intracranial pressure
    headache
    nausea and vomiting
    somnolence (falling asleep, very drowsy mid conversation)
    apathy, poor concentration
    memory impairment and personality change
  • lumbar pain (spinal tumour)
  • bladder/bowel dysfunction (spinal tumours)
  • hydrocephalus
    obstruction of CSF circulation leading to papilloedema (optic disc swelling)
45
Q

clinical presentation brain tumours

A

focal neurological symptoms:
- correspond to affected part of brain
- dysfunction caused by ischemia of neural tissue
- ischemia caused by local pressure from tumour

46
Q

clinical presentation spinal tumours

A
  • pain
    75% pts present with pain
    often localised to involved region
    radicular pain illustrates tumour in the associated root (pain beyond the spinal cord)
  • numbness
    can replace pain, more advanced sign
    spinal nerve involvement/involvement of nerve tract
  • spinal cord compression
    lesion between foramen magnum and L1/L1
    upper motor neurone loss of function below the level of the compression
    (upper motor neurons are a first type of first order neuron. they are unable to leave the CNS)
    associated sensory loss
    sphincter disturbance
  • cauda equina compression
    lesion lies below lower limit of spinal cord
    affects only nerve roots
    signs of a lower motor neurone disturbance
    lower motor neurone or second order neurons are cranial and spinal nerves. the cell bodies of these neurone are located in the brainstem, but their axons can leave the CNS and synapse with the muscles of the body.
    affects lower limbs: hypotonia, weakness, wasting, dermatonal sensory loss, sphincter disturbance
47
Q

diagnostic workup CNS tumours

A
  • complete history and physical exam
  • complete neurological examination (LQS Bloom Scale)
  • opthalmoscopy: papilloedema for raised ICP
  • detailed imaging
  • biopsy if possible
  • CSF cytology
48
Q

diagnostic imaging

A

MRI is the main diagnostic imaging and modality
- T1 pre and post gadolinium, T2 and FLAIR
contrast agents highlight blood vessels. gadolinium can cross the blood brain barrier. T2 dampens the noise. FLAIR dampens the signal coming from the CSF
- Post-op MRI within 48 hours to document any residual disease
-PET: Juvenile Pilocytic Astrocytoma has a high uptake on PET
- MR spectroscopy: tumour = increased choline, decreased creatine, decreased N-Acetylaspaetate (marker of viable neurons)
- Dynamic MR perfusion - checks the flood flow through the tumour (cerebral blood volume (CBV). Increasing grade of astrocytoma correlates with a similar increase in CBV

49
Q

WHO classification of CNS tumours
NOS suffix

A

‘not otherwise specified’
added when the diagnostic information necessary to assign a specific WHO diagnosis is not available

50
Q

WHO classification of CNS tumours
NEC suffix

A

‘not elsewhere classified’
indicates that the necessary diagnostic testing has been successfully performed but the results do not permit a WHO diagnosis

Radiation Therapy in Practice (19 decks)

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