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Neurology > Tumours of the Nervous System > Flashcards

Tumours of the Nervous System Flashcards

1
Q

What is the most common extra-axial tumour?

A

Meningioma

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2
Q

What can brain tumours be categorised into?

A
  • benign or malignant
  • primary or secondary
  • supratentorial and infratentorial
  • extrinsic of intrinsic
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3
Q

Brain tumours are the __ most common tumour in children.

A

Brain tumours are the 2nd most common tumour in children.

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4
Q

What is the typical presentation of brain tumours?

A
  • progressive neurological deficit- 68%
  • usually motor weakness - 45%
  • headache- 54%
  • seizures- 26%
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5
Q

What symptoms does increased intracranial pressure cause?

A

Headaches

Vomiting

Mental Changes

Seizures

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6
Q

When is a headache worrying?

A

When it wakes them up from sleep in the morning

When it is worse on coughing or leaning forward

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7
Q

What is the aetiology of tumour headaches?

A
  1. Raised ICP
  2. Invasion/compression of dura, BVs, periosteum
  3. 2ry to diplopia (CN III, IV, VI, INO)
  4. 2ry to difficulty focusing
  5. extreme hypertension (cushings triad of Increased ICP)
  6. psychogenic (stress of loss of functional capacity)
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8
Q

Which neuroepithelial tissues can tumours arise from?

A
  1. Astrocytes (60%- 2/3 of which are high grade)
  2. Oligodendroglial cells
  3. Ependymal cells/choroid plexus
  4. Neuronal cells
  5. Pineal cells
  6. Embryonic
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9
Q

Glial tumours arise from ______ or ________ and exist along a spectrum of varying ________.

A

Glial tumours arise from astrocytes or oligodendrocytes and exist along a spectrum of varying malignancy.

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10
Q

How does WHO grade astrocytic tumours?

A

I. Pilocytic, pleomorphic xanthoatrocytoma, subependymal giant cell

II. Low grade astrocytoma

III. Anaplastic astrocytoma

IV. Glioblastoma multiforme

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11
Q

Grading of astrocytic tumours is based on what?

A

Pathologic features;

  • endothelial proliferation
  • cellular pleomorphism
  • mitoses
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12
Q

What is the prognosis of grade I and II astrocytic tumours?

A

Grow slowly but have propensity to transform into malignant neoplasms over time

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13
Q

Describe grade I astrocytomas?

A
  • benign
  • slow growing
  • children, young adults
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14
Q

Where are pilocytic astrocytomas found?

A

optic nerve, hypothalamic gliomas

cerebellum, brainstem

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15
Q

What is the treatment of choice for grade I astrocytomas?

A

Surgery= curative

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16
Q

What do low grade astrocytomas show on further examination?

A

Hypercellularity

Pleomorphism

Vascular proliferation

Necrosis

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17
Q

Where do low grade astrocytomas have a predilection for?

A

Temporal lobe

Posterior frontal

Anterior parietal

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18
Q

What is the commonest presentation of low grade astrocytomas?

A

Seizures

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19
Q

What are the poor prognostic factors for low grade astrocytoma?

A

Age >50

focal deficit (seizures)

Short duration of symptoms

Raised ICP

Altered consciousness

Enhancement on contrast studies

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20
Q

What is the treatment for grade II astrocytomas?

A

Surgery +/-

  • serial imaging, radiation, chemotherapy, radiation

depending on molecular profile

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21
Q

What molecular profile confers a better chance of surviving a grade II astrocytoma?

A

IDH-1 and Ip19q co-deletion

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22
Q

What are the two forms of surgery for grade II astrocytomas?

A

Sterotactic vs open

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23
Q

What are the poor prognostic factors for grade II astrocytomas?

A
  • Age >45
  • Low performance score
  • large tumours (dia >6cm)/crossing midline
  • incomplete resection
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24
Q

Which grades of malignant astrocytomas are considered malignant?

A

grades III-IV

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25
Q

What is the median survival of anaplastic astrocytoma?

A

2 years

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26
Q

What is the most common primary brain tumour?

A

Glioblastoma multiforme

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27
Q

What is the pattern of spread of glioblastoma multiforme?

A

White matter tracking/CSF pathways

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28
Q

What is the median survival of glioblastoma multiforme?

A

<1 year

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29
Q

What is seen in glioblastoma multiforme?

A

multiple gliomas (NF, TS, PML)

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30
Q

What is the treatment for malignant astrocytomas?

A

Noncurative surgery

  • cytoreduction
  • reduce mass effect

Supramarginal resection if non-eloquent

Post operative radiotherapy: external beam radiation

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31
Q

What chemotherapy agents are used?

A

Temozolomide

PCV (Procarbazine, CCNU, vincristine)

Carmustine wafers

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32
Q

where does radiotherapy have a role in astrocytomas?

A

in malignant tumours post surgery

in low grade astrocytomas where there is incomplete removal

in benign astrocytomas where recurrence is not amenable to surgery

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33
Q

What are the side effects of radiotherpay to the brain?

A

Drops IQ by 10, skin, hair, tiredness

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34
Q

Oligodendroglial tumours make up __% of glial tumours?

A

20%

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35
Q

Where do oligodendroglial tumours present?

A

Frontal lobes

36
Q

When do oligodendroglial tumours present?

A

In adults aged 25-45 (small peak in children 6-12)

37
Q

How do oligodendroglial tumours present?

A

With seizures

38
Q

How can oligodendroglial tumours be distinguished from astrocytomas?

A
  • Calcification
  • Cysts
  • Peritumoural haemorrhage
39
Q

What are collision tumours?

A

Oligodendroglial cells coexist with astrocytic cells in a neoplastic collision type of tumour. possibly originate from the common precursor to oligodendrocytes and astrocytes: O2A cells

40
Q

How are oligodendroglial tumours graded?

A
  • low grade
  • anaplastic/astrocytic component
41
Q

What is the treatment for oligodendroglial tumours?

A

Chemosensitive

  • procarbazine, lomustine, vincristine
  • Surgery + chemotherapy
  • Radiotherapy + PCV in high grade doubles survival
42
Q

What signs are worrying in children?

A

Tiptoeing

Ataxia

Vomiting with headache

43
Q

What do menigniomas arise from?

A

Arachnoid cap cells

44
Q

Meningiomas make up __% of ____cranial neoplasms

A

Meningiomas make up 20% of intracranial neoplasms

45
Q

What is meningioma en plaque?

A

Morphological subgroup where the meningiomas defined by a carpet or sheet-like lesion that infiltrates the dura and the bone

46
Q

What are the 4 kinds of meningiomas?

A
  • parasagittal
  • convexity
  • sphenoid
  • intraventricular
47
Q

What are the symptoms of meningiomas?

A
  • headaches
  • skull base: cranial nerve neuropathies
  • regional anatomical disturbance
48
Q

90% of meningiomas are histoligically _____

A

benign

49
Q

What is the classification system for meningiomas?

A
  • classic (meningiotheliomas, fibrous, transitional)
  • angioblastic
  • atypical (2%)
  • malignant (5%)
50
Q

What are the aggresive types of meningiomas?

A
  • clear cell
  • choroid
  • rhaboid
  • papillary
51
Q

Why do meningiomas occur after childhood leukaemia?

A

As a result of radiation- typically in midline

52
Q

What is seen on CT of a meningioma?

A
  • Homogenous, densly enhancing
  • Oedema
  • Hyperostosis/skull ‘blistering’
53
Q

What is seen on MRI of meningiomas?

A

Dural tail

Patency of dural sinuses

54
Q

What is looked for on angiograpgy of meningiomas?

A

External carotid artery feeders

Occlusion of sagittal sinus

55
Q

Which vessels usually supply meningiomas?

A

Dural arteries

56
Q

What is the treatment for meningiomas?

A

Small meningiomas: expectant

  • preoperative embolisation
  • surgery
  • radiotherapy
57
Q

What is the outcome for meningiomas?

A

5 year survival 90%

58
Q

What is the recurrence rate with the different grades of resection?

A

I- 9% symptomatic recurrence at 10 yrs

II- 19% symptomatic recurrence at 10 years

III- 29% symptomatic recurrence at 10 years

IV- 44% sumptomatic recurrence at 10 years

V- 100% symptomatic recurrence at 10 years

59
Q

What are the different nerve sheath tumours?

A

Schwannomas

Neurofibromas

Malignant peripheral nerve sheath tumours

60
Q

What are acoustic neuromas?

A

Vestibular schwannomas of CN VIII

61
Q

How do acoustic schwannomas present?

A

Hearing loss

Tinnitus

Dysequlilbrium

62
Q

What can be affected as a result of an acoustic neuroma?

A

V, VII, VIII cranial nerves

Brainstem function

CSF drainage- hydrocephalus

63
Q

What is the assessement for acoustic neuroma?

A

Audiologic/audiometry

Radiographic evaluation

64
Q

What is the treatment for acoustic neuromas?

A

Expectant

Hydrocephalus management

Radiation

Surgery

65
Q

What is involved in medical management of acoustic neuromas?

A
  • periodic neurological examination
  • hearing aid
  • periodic MRI
66
Q

What is radiosurgery?

A

A way of treating in-brain lesions which uses convergence of very thin multiple ionisation beams in a unique focus point coinciding with the target.

67
Q

What is the prognosis of treated AN?

A

Hearing gradually declines in treated ear

Malignant transformation is rare

68
Q

What are the possible adverse effects of AN surgery?

A

Facial nerve palsy

Corneal reflex lost

Nystagmus

Abnormal eye movement

69
Q

What age group/gender typically get germ cell tumours?

A

90% occur in those younder than 20yo

M>F

70
Q

What is seen on CT of germ cell tumours?

A

They are iso or hyperdense

71
Q

How do germ cell tumours metastasise?

A

Via CSF

72
Q

What is the most common CNS germ cell tumour?

A

Germinomas

73
Q

Germinomas are sensitive to _________ and have a __-__% 5 year survival

A

Germinomas are sensitive to radiotherapy and have a 65-95% 5 year survival

74
Q

What are the non germinomatous germ cell tumours?

A
  • teratoma (mature/immature)
  • yolk sac tumour
  • choriocarcinoma
  • embryonal carcinoma
75
Q

What is the prognosis for non-germinomatous germ cell tumours?

A

They are less radiosensitive (17-38% 5 year survival)

76
Q

What tumour markers should be tested for in any child with a midline brain tumour?

A

Alpha-Fetoprotein, BetaHCG, LDH

77
Q

What produces AFP and what tumours is it raised in?

A

Yolk sac endoderm and embryonic intestinat epithelium

Present in yolk sac tumours (and teratomas)

78
Q

What produces HCG and which tumours cause it to rise?

A

Synthesised by syncytiotrophoblasts

Present in choriocarcinoma (and germinoma)

79
Q

What produces placental alklaking phosphatase and which tumours cause increased levels?

A

Primordial germ cells and syncytiotrophoblasts

Present in germinoma (and choriocarcinoma and tolk sac)

80
Q

If tumour markers are negative what must be done?

A

A biopsy

  • test tumour markers in CSF
81
Q

Why do LP shunts eventually fail?

A

Terminal slit valves fail with time

82
Q

What is the common presenting complaint of pituitary tumours?

A

Bitemporal hemianopia, HA, endocrine abnormality

83
Q

What is the treatment for a prolactinoma?

A

Cabergoline

84
Q

What is the treatment for increased GH, IGF-1 as a result of pituitary tumour?

A

Acromegaly can kill from HOCM- need surgery and somatostatin analogues

85
Q

Describe the phenotype of panhypopituitarism?

A

Pallor, yellowish tinge to skin

Fine wrinkling of skin

Absent axillary hair

Face pully & expressionless

86
Q

What is the aetiology of panhypopituitarism?

A
  • GH lost first
  • LH, FSH nect
  • TSH
  • ACTH
  • prolactin
87
Q

What is common after surgery to the pituitary?

A

Temporary diabetes insipidus

Neurology (41 decks)

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