Week 5 Tumours Flashcards
Describe the presentation, symptoms and course of glioblastoma multiforme
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
Describe the presentation, symptoms and course of Astrocytoma
Any age, slow growing, benign, characterised by seizures , symptoms may be present for a long time, excision allows for long survival,
Describe the presentation, symptoms and course of medulloblastoma
Rapid growth, common in children, always located in the cerebellum
What are some blood vessel tumors?
Angioblastomas and angiomas
What are some symptoms of brain tumours?
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
What are some focal effects of a prefrontal lobe tumour?
Often hard to localise headache early followed by vomitting mental symptoms (often unnoticed) convulsions expressive dysphasia (If Broca's) unilateral grasp
What are some focal effects of a precentral lobe tumour?
involves motor cortex so focal convulsion
motor weakness
What are some focal effects of a temporal lobe tumour?
epilepsy, visual defect, auditory hallucinations, aphasia (left hemi)
What are some focal effects of a parietal lobe tumour?
sensory disturbance, visual field defects, visual and sensory inattention,
if left: dyslexia, dysgraphia, finger agnosia, dyscalculia
What are some focal effects of a third ventricle tumour?
Severe headache, coma
How may you choose to investigate for a tumour?
History, neurological examination, lumbar puncture, EEG, CT/MRI, angiography, cerebral biopsy,
What are some treatment considerations for a tumour?
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,
Where did the barrister with the tumour who was appraised to go back to work have a tumour?
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,
What about the father seeking unsupervised access to his children?
Right adrenal phaeochromocytoma, cognitive decline, very guarded, distractible, confused disorganised, impulsive, disinhibited,
Explain how environment changes brain structure?
Experience changes the structure of the brain, complex environment leads to larger neurones, and more synapses, increased sensory processing, and larger astrocytes,
What are some critical periods of brain development for humans?
6-19months? Romanian orphans!
2nd half of pregnancy and first few months after birth
What is post-natal growth in brain due to ?
formation of new synapses, myelination, increased branching of dendrites,
What area of the brain takes the longest to develop?
Prefrontal cortex
Explain how the mechanisms and limits of neural plasticity
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
Talk about cerebral reorganisation
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)
Give an example of the effects of an early insult injury
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,
