Week 5 Tumours

Question 1

Describe the presentation, symptoms and course of glioblastoma multiforme

Answer 1

Extremely malignant, arise in middle life, very invasive, symtoms present up to 6months beofre diagnosis, less than 1/5 of all patients survive for one year after the onset of symptoms

Question 2

Describe the presentation, symptoms and course of Astrocytoma

Answer 2

Any age, slow growing, benign, characterised by seizures , symptoms may be present for a long time, excision allows for long survival,

Question 3

Describe the presentation, symptoms and course of medulloblastoma

Answer 3

Rapid growth, common in children, always located in the cerebellum

Question 4

What are some blood vessel tumors?

Answer 4

Angioblastomas and angiomas

Question 5

What are some symptoms of brain tumours?

Answer 5

Function is dependent on maintenance and circulation of blood and CSF, ICP may increase, direct obstruction of ventricular system(Pressure on brain tissue causes agitation, decreased response and coma), brain tissue displaced,

Headache, vomiting, papilloedema

Symptoms are variable dependent on nature and site of tumour - most common - increased ICP, seizure, destroying brain tissue, hormone regulation, mental or personality changes suggestive of lesion

FAST Growing- puts pressure on brain structres, affecting function
SLOW growing - allows for displacement, thus not affecting function

Question 6

What are some focal effects of a prefrontal lobe tumour?

Answer 6

Often hard to localise
headache early followed by vomitting
mental symptoms (often unnoticed)
convulsions
expressive dysphasia (If Broca's)
unilateral grasp

Question 7

What are some focal effects of a precentral lobe tumour?

Answer 7

involves motor cortex so focal convulsion

motor weakness

Question 8

What are some focal effects of a temporal lobe tumour?

Answer 8

epilepsy, visual defect, auditory hallucinations, aphasia (left hemi)

Question 9

What are some focal effects of a parietal lobe tumour?

Answer 9

sensory disturbance, visual field defects, visual and sensory inattention,
if left: dyslexia, dysgraphia, finger agnosia, dyscalculia

Question 10

What are some focal effects of a third ventricle tumour?

Answer 10

Severe headache, coma

Question 11

How may you choose to investigate for a tumour?

Answer 11

History, neurological examination, lumbar puncture, EEG, CT/MRI, angiography, cerebral biopsy,

Question 12

What are some treatment considerations for a tumour?

Answer 12

Radiotherapy can improve outcome, debulking increases survival time, chemo may improve duration, can cause cognitive effects (necrosis of white matter, vascular damage), memory loss, (elderly more susceptible to radiation induced atrophy)

Surgery can resect or just debulk, surgery risk must be taken into account,

Question 13

Where did the barrister with the tumour who was appraised to go back to work have a tumour?

Answer 13

Left parietal gliobastoma multiforme, radiation and chemo, word finding problems, memory decline, distractible, unable to deal with lots of data,

Conclusion - pervasive organis cognitive impairment - likely to impede previous work as a barrister,

Question 14

What about the father seeking unsupervised access to his children?

Answer 14

Right adrenal phaeochromocytoma, cognitive decline, very guarded, distractible, confused disorganised, impulsive, disinhibited,

Question 15

Explain how environment changes brain structure?

Answer 15

Experience changes the structure of the brain, complex environment leads to larger neurones, and more synapses, increased sensory processing, and larger astrocytes,

Question 16

What are some critical periods of brain development for humans?

Answer 16

6-19months? Romanian orphans!

2nd half of pregnancy and first few months after birth

Question 17

What is post-natal growth in brain due to ?

Answer 17

formation of new synapses, myelination, increased branching of dendrites,

Question 18

What area of the brain takes the longest to develop?

Answer 18

Prefrontal cortex

Question 19

Explain how the mechanisms and limits of neural plasticity

Answer 19

Brain can adapt to different experiences by changing the way functions are represented, ie.e. following amputation the somatosensory cortex with have a larger representation fo the face compared to the limbs - there are limits constrained by the boundaries of the inputs, different receptors go to a different area, cannot take them over

Question 20

Talk about cerebral reorganisation

Answer 20

evidence in the very young, that damage to a hemisphere (e.g.left) can result int he right hemisphere taking over the functions of the damaged hemisphere (right now does language), however, this is at a cost to the function of the right cerebral hemis other functions (i.e. visuospatial)

Question 21

Give an example of the effects of an early insult injury

Answer 21

17-yr old, car accident, skull fracture, cerebral oedema, CSF leak plus seizures, disinhibition,, disruptive, 24hr carers, argumentative, no insight, gives up, poor planning, poor rule following,