Tumours of the Nervous System Flashcards
presentation of brain tumour?
PROGRESSIVE neurological deficit usually motor weakness headache seizures (from most to least common)
features of raised ICP?
headache
vomiting
mental changes
seizures
causes of raised ICP?
mass
oedema
CSF flow blockage (hydrocephalus)
haemorrhage
uncal herniation causes what symptoms?
blown pupil (compresses CN III)
tonsillar herniation causes what symptoms?
cushings response?
can brain cope well with raised ICP?
no
headache die to raised ICP?
worse in the morning wakes you up worse with coughing/leaning forward associated with and worsened by vomiting basically similar to migrane
what do you do if suspected ICP headache?
fundoscopy
look for papilloedema
causes of tumour heacache?
raised ICP invasion/compression of dura, BVs, periosteum 2ndary to diplopia 2ndary to trying to focus eyes extreme hypertension
DANISH?
//
suspected brain tumour investigations?
imaging lesion biopsy EEG evoked potential angiograms radionucleotide studies
most common cause of brain tumour?
metastases
what cells can cause primary brai tumours?
astrocytes (60%) oligodendroglial cells ependymal cells neuronal cells ..
grading of brain tumours?
molecular classification now was graded 1-4 - 1 = pilocytic, pleomorphic xanthanoastrocytoma subependymal giant cell - 2 = low grade astrocytoma - 3 = anaplastic - 4 = glioblastoma
grade 1 astrocytoma?
truly benign slow growing children/young adults optic nerve, cerebellum generally take up contrast very well treatment = surgery (curative)
grade 2 astrocytoma?
fibrillary, gemistocytic, protoplasmic
hypercellularity
don’t take up contrast (unlike grade 1)
tend to present with seizures
ultimately not benign (turn malignant and higher grade over time)
treatment = surgery if safe +/- chemo/radiotherapy
poor prognostic factors for grade 2 astrocytoma?
age >50 focal deficit short duration of symptoms raised ICP altered conscious enhancement on contrast studies
grade 3 astrocytoma?
malignant
anaplastic
can arise de novo
median survival = 2 years
grade 4?
glioblastoma multiforme
most common primary tumour
median survival = <1 year
spread along white matter, tracking CSF pathways
management of grade 3-4?
surgery not curative but can help symptoms
post op radiotherapy
combination of surgery + radiotherapy + chemo = survival increased to 14 months but often not done as 2 months doesn’t really make a difference
how is tumour identified during surgery?
patient given drink of 5-ALA which causes tumour cells to appear pink under blue light
who must be informed after a patient has had any brain surgery?
DVLA
patient cannot drive after any brain surgery (seizure risk)
what chemo is used?
temozolomide
PCV
carmustine wafers
use of radiotherapy in brain tumours?
clear role in post op malignant tumours
………
oligodendroglial tumour?
20% of glial tumours …. present with seizures generally in frontal lobe … difficult to distinguish ………. treatment = surgery + chemotherapy (PCV)
danger signs of brain tumour in children?
tiptoeing, ataxia, vomiting with headache
meningioma?
arachnoid cap cells extra-axial 20% of intracranial neoplasms most are asymptomatic most common in women can spread from breast cancer? presentation = cranial nerve palsy, headache slow growing
aggressive meningiomas?
clear cell choroid rhabdoid papillary radiation induced meningiomas (after childhood leukaemia, typically in midline)
investigation of meningioma?
CT - homogenous, dense enhancing, oedema
MRI - …….
angiography +/- embolization - ………..
management of meningioma?
expectant if small (leave alone) pre-op embolization surgery radiotherapy recurrence 90% 5 year survival
types of nerve sheath tumours?
schwannomas (AKA neuromas)
neurofibromas
malignant peripheral nerve sheath tumours
commonest nerve sheath tumour?
acoustic neuroma/schwannoma (vestibular)
- hearing loss, tinnitus, disequilibrium, can cause hydrocephalus
5th/7th/8th CNs
management of acoustic schwannoma?
expectant (25%)
surgery
radiation
manage hydrocephalus
how do pineal tumours present?
para…. syndrome
nystagmus?
…..
all extra-ocular muscles are compromised?
pineal tumour?
// can be germ cell?
tumour makers on bloods?
AFP HCG LDH - perform for any midline brain tumour in a child - perform a biopsy if negative
how is hydrocephalus managed?
VP shunt
features of pituitary tumour?
bitemporal hemianopia
headache
endocrine abnormality
tests for pituitary tumour?
prolactin measure (prolactinoma can generally be managed with cabergoline) early morning cortisol GH/IGF-1 thyroid function tests FSH/LH visual fields
