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NEUROLOGY > Tumours of the Nervous System > Flashcards

Tumours of the Nervous System Flashcards

1
Q

Supra/infra tentorial describes tumours above and below what structure in the brain?

A

Tentorium cerebelli

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2
Q

How do brain tumours usually present?

A

Neurological deficit
Motor weakness
Headache (due to raised ICP)
Seizures

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3
Q

Most brain tumours are secondary. TRUE/FALSE?

A

TRUE

Most are metastases

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4
Q

How does hydrocephalus usually present?

A

sudden raised ICP
=> headache
=> vomiting (due to vomiting centre in thalamus)
=> seizures

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5
Q

An uncal transtentorial herniation presses on which cranial nerve, causing what symptom?

A

Presses on CN III
=> prevents parasympathetics reaching pupil
=> sympathetics unopposed
=> dilated “Blown out” pupil

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6
Q

What features of a headache would make you suspicious of a raised ICP?

A

Headaches which wake the patient up

OR if it gets worse when coughing/leaning forward

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7
Q

What other symptoms are usually present with a tumour headache?

A
  • Diplopia (double vision)
  • difficulty focussing
  • extreme hypertension (cushings triad)
  • psychogenic
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8
Q

What behaviours would be affected if the frontal and/or parietal lobes were affected by a tumour?

A

Thought
Reasoning
Behaviour
Intellect

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9
Q

What would be impaired if the occipital lobe was affected by a tumour?

A

Speech

Vision

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10
Q

The referral guidelines suggest a referral after presentation of what symptoms?

A
  • behaviour change
  • seizure
  • headache
  • focal neuro deficit
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11
Q

What investigations would be carried out after a referral for a possible neurological tumour?

A

MRI
Lumbar puncture for CSF markers
Biopsy may be used, but ultimately surgeon may attempt full excision

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12
Q

Is papilloedema a late or early sign of raised ICP?

A

LATE

<10% have this on presentation with increased ICP

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13
Q

What general symptoms should be checked if suspicion of brain metastases is high?

A
  • unintentional weight loss
  • haemoptysis/haematuria
  • evidence of melanoma on skin
  • check axillae for freckling => neurofibromatosis Type 1
  • check toenails for subungual keratomas => tuberous sclerosis
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14
Q

What are the 4 grades of nervous system tumours set out by the WHO?

A

I - benign
II - pre-malignant (can change over years)
III - malignant
IV - aggressively malignant

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15
Q

Where and in what what patient groups are Grade 1 astocytomas normally found?

A

Cerebellar/ brainstem tumours

found in children and young adults

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16
Q

How quickly do grade 1 astrocytomas grow, and how are they treated?

A 
Grow slowly (benign)
Tx: surgical excision
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17
Q

Grade 1 astrocytomas take up contrast on CT. TRUE/FALSE?

A

TRUE

Look like meningiomas on CT

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18
Q

Where do low grade astrocytomas (Grade II) present and what symptoms are usually experienced?

A

Temporal lobe
Anterior parietal/posterior frontal lobes

  • present with seizures
19
Q

DO grade II astrocytomas take up contrast?

A

No

Look well circumscribed BUT difficult to see exact margins

20
Q

Grade II astrocytomas can progress to grade III or IV. TRUE/FALSE?

A

TRUE

21
Q

What indicates a poor prognosis?

A

> 50 years old

  • focal deficit
  • short symptom duration
  • raised ICP
  • altered conciousness
  • enhances with contrast (both grade III and IV do this)
22
Q

When would it be unsafe to excise a tumour?

A

If it is in an area of the pons/brainstem where removal would cause significant damage

23
Q

What genetic co-deletion increases chance of survival post-resection?

A

IDH-1 1p19q co-deletion

24
Q

Radiotherapy and chemotherapy in combination after surgery have imporved life expectancy. TRUE/FALSE?

A

TRUE

25
Q

What is the average life expectancy for a patient diagnosed with grade IV glioblastoma?

A

14 months

26
Q

What substance is used to highlight tumour outlines during surgery?

A

5-ALA Protoporphyrin 9 (patients drink this prior)

When illuminated with blue light = pink

27
Q

Patients who have surgery to excise a glioma are not allowed to drive afterwards. Why is this?

A

Seizure risk

OR visual field defect

28
Q

What oral chemotherapy agent is sometimes used after surgery?

A

Temozolomide

29
Q

Where do oligodendroglial tumours (grade II) usually arise and in which patient group are they most common?

A

Frontal lobe

25-45 years old

30
Q

What is used to treat oligodendroglial tumours (grade II) ?

A

PCV (procarbazine, lomustine and vincristine)

- as they are chemosensitive

31
Q

What symptoms in a child would make you consider a posterior tumour?

A

Tiptoeing OR ataxic gait
vomiting
headache

32
Q

Who should all neurooncology patients be referred to?

A

Macmillan nurses

33
Q

What is psychomotor retardation?

A

Patients lose capacity as a result of their tumour and become apathetic

34
Q

Meningiomas are mainly asymptomatic. TRUE/FALSE?

A

TRUE

35
Q

Females are more likely to get meningiomas than males. TRUE/FALSE?

A

TRUE (3:2)

36
Q

What can patients with meningiomas possibly present with?

A

CN palsies

headache

37
Q

What are the types of aggressive meningiomas?

A

Clear cell
Chordoid
Rhabdoid
Papillary

likely to recur and need second surgery

38
Q

Why do frontal lobe tumours in the elderly present late?

A

Symptoms overlap with cognitive decline of elderly anyway

39
Q

How are meningiomas treated?

A

Small => leave alone

Larger => surgery (esp. if neuro deficit)

40
Q

When is complex surgery for acoustic neuromas used?

A

If 4th ventricle has become blocked off => causing hydrocephalus

41
Q

How many hydrocephalus shunts stop working after 10 years?

A

50%

42
Q

What side effects can occur after an operation to excise a tumour?

A

facial nerve palsy
corneal reflex
nystagmus

43
Q

What symptoms are present in a pineal tumour?

A
  • nystagmus
  • weak upwards gaze
  • eyes bulge forward as extra-ocular muscles are compressed
  • hydrocephalus
44
Q

What tumour markers are important in nervous system tumours?

A

Alpha-feto protein
HCG
LDH
if these are negative - do biopsy

NEUROLOGY (29 decks)

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