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MBChB - Y2 - Systems - Nervous System > Brain Tumours (clinical) > Flashcards

Brain Tumours (clinical) Flashcards

1
Q

What are the common metestatic sites for spread to the brain?

A

Lung

Breast

Kidney

GI

(previous lecture also included melanoma)

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2
Q

How do we classify brain tumours?

A

Tissue of origin

ocation

Primary or secondary

Grading

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3
Q

What percentage of cancer patients develop brain mets?

A

10-15%

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4
Q

What are the two most likely causes of neurological death?

A
  1. Stroke
  2. Brain tumour
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5
Q

How do we grade tumours?

A

Microscopic appearence

Growth rate

To grade differentiation:

oGX Grade cannot be assessed (Undetermined)

oG1 Well-differentiated (Low grade)

oG2 Moderately differentiated (Intermediate grade)

oG3 Poorly differentiated (High grade)

oG4 Undifferentiated (High grade)

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6
Q

What are the common presentations of brain tumour?

A

Neurological defecit: 68%

  • 45% motor weakness
  • Mental status changes

HA 54%

Seizures 26%

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7
Q

What are the genereal signs and symptoms of brain tumours?

A

oCerebral edema

oIncreased intracranial pressure

oFocal neurologic deficits

oObstruction of flow of CSF

oPituitary dysfunction

oPapilledema (if swelling around optic disk)

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8
Q

What are the signs and symptoms of cerebral tumours?

A

oHeadache

oVomiting unrelated to food intake

oChanges in visual fields and acuity

oHemiparesis or hemiplegia

oHypokinesia

oDecreased tactile discrimination

oSeizures

oChanges in personality or behavior

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9
Q

What are the signs and symptoms for brainstem tumours?

A

oHearing loss (acoustic neuroma)

oFacial pain and weakness

oDysphagia, decreased gag reflex

oNystagmus

oHoarseness

oAtaxia (loss of muscle coordination) and dysarthria (speech muscle disorder) (cerebellar tumours)

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10
Q

What are the signs and symptoms of cerebellar tumours?

A

Disturbances in coordination and equilibrium

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11
Q

What are the signs and symptoms of pituitary tumours?

A

Endocrine dysfunction

Visual defecits

Headache

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12
Q

What are the signs and symptsoms of frontal lobe tumours?

A

oInappropriate behavior

oPersonality changes

oInability to concentrate

oImpaired judgment

oMemory loss

oHeadache

oExpressive aphasia

oMotor dysfunctions

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13
Q

What are the signs and symptoms of parietal lobe tumour?

A

Sensory defecits:

  • Paresthesia
  • Loss of 2 point discrimination
  • Visual field defecits
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14
Q

What are the signs and symptoms for temporal lobe tumours?

A

oPsychomotor seizures – temporal lobe-judgment, behavior, hallucinations, visceral symptoms, no convulsions, but loss of consciousness

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15
Q

What are the signs and symptoms of ocipital lobe tumours?

A

Visual disturbances

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16
Q

What is the name given to grade a) 1 and 2 b) 3 c) grade 4

Gliomas?

A

Grade 1 and 2 glioma - astrocytoma

Grade 3 - anaplastic astrocytoma

Grade 4 - Glioblastoma multiforme (also known as a glioblastoma)

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17
Q

What are the intraaxial tuomurs?

A

•Gliomas

oAstrocytoma (Grades I & II)

oAnaplastic Astrocytoma(III)

oGlioblastoma Multiforme(IV)

  • Oligodendroglioma
  • Ependymomas
  • Medulloblastoma
  • CNS Lymphoma
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18
Q

What are the extraaxial tumours?

A
  • Meningioma
  • Metastatic
  • Acoustic neuromas (Schwannoma)
  • Pituitary adenoma
  • Neurofibroma
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19
Q

What are the most common brain tumours?

A
  1. Gliomas
  2. Meningioma
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20
Q

What age group is most commonly affected by meningiomas?

A

Usually age 40 - 70

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21
Q

Is meningioma usually invasive or non-invasive?

A

Usually non - invasive

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22
Q

Where are meningiomas usually located?

A

Parasaggital region

SPhenoid wing

Parasellar region

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23
Q

What is the presentation of a meningioma?

A

Asymptomatic

Symptomatic: Focal or generalised seizure or gradually worsening neurological defecit

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24
Q

What are the features of meningioma on CT?

A

Cearly demarcated contours

Frequently have areas of calcification

Isodense or hypodense

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25
Q

WHich demographic is affected by diffuse low grade astrocytomas?

A

Young adults

26
Q

Where do you find astrocytoma?

A

Frontal region

Subcortical white matter

27
Q

What is the presentation of astrocytoma?

A

Seizures

Headache

Slowly progressive neurological defecits

28
Q

What are the findings of diffuse low grade astrocytoma on CT?

A

Well circumscribed

Hypodense or isodense

MRI is more sensitive than CT

29
Q

What is the most common type of brain tumour in adults?

A

Glioblastoma

30
Q

Where can glioblastomas arise from?

A

May arise de novo (from new) or may evolve from a low grade glioma

31
Q

What does an astrocytoma resemble?

A

Can look like a butterfly lesion

32
Q

What is the location of a glioblastoma?

A

Frontal and temporal lobe

Basal ganglia

33
Q

What is the presentation of a glioblastoma?

A

Seizures

Headache

SLowly progressive neurological defecit

34
Q

What are the findings of high grade astrocytoma on CT?

A

Hypodense or isodense

Central hypodense area of necrosis surrounded by a thick enhancing rim

Surrounding oedema

35
Q

What is the typical appearance of an oligodendroglioma?

A

Characteristic fried egg appearance

Arises from myelin

36
Q

What is the location of an oligodendroglioma?

A

FOund superficially in the frontal lobe

37
Q

What is the presentation of oligodendroglioma?

A

Seizures most common

Headache

Slowly progressive neurologic deficits

38
Q

What are the features of oligodendroglioma on CT?

A

Well circumscribed

Hypodense lesions with heavy calcification

Cystic degeneration is common

39
Q

What are examples of haemorrhagic brain mets?

A

Melanoma

Renal cell

Choriocarcinoma

40
Q

What are the diagnostic procedures of brain tumours?

A

•Radiological Imaging

oComputed Tomography scan (CT scan) with/without contrast

oMagnetic Resonance Imaging (MRI) with/without contrast

oPlain films

oMyelography

oPositron Emission Tomography scan (PET scan)

  • LP/CSF analysis
  • Pathology
41
Q

Why would you use a CT and MRI?

A

CT - Diagnosis of brain tumours

MRI - Folow-up of brain tumours

42
Q

What might a CT scan miss?

A

May miss small tumours

May miss tumours adjacent to the bone such as (pituitary adenomas, clival tumours and vestibular schwannoma)

May miss brainstem tumours

Low grade astrocytoma

43
Q

What is a CT more sensitive to than an MRI scan?

A

More sensitive than MRI for detecting acute haemorrhage, calcification and bony involvement

44
Q

What are the advantages of MRI over CT?

A

More sensitive than CT scans

Can detect small tumours

Provides much greater anatomic detail

Especially useful for visualizing skull base, brain stem and posterior fossa tumours

45
Q

When are steroids used for brain tumour patients?

A

Pre-operatively

46
Q

What is surgical treatment for brain tumours?

A

Resection

Biopsy

Craniotomy

Stereotaxis surgery

Transsphenoidal

Endoscopic

47
Q

What are post - op complications?

A
  • Increased ICP
  • Hematoma
  • Hypovolemic shock
  • Hydrocephalus
  • Atelectasis - partial collapse or incomplete inflation of the lung
  • Pulmonary edema
  • Meningitis
  • Fluid and electrolyte imbalances (ADH)
  • Wound infection
  • Seizures
  • CSF leak
  • Edema
48
Q

How does radiation therapy work?

A

Damages cells that rapidly divide - sensitive to these cells

Usually lasts 4 - 8 weeks

49
Q

What is a common side effect of radiation therapy?

A

Skin burn and reddened skin from beam of radiation

50
Q

How is cerebral oedema controlled before radiation therapy begins?

A

Corticosteroids are given beforehand

51
Q

Why might surgery be indicated after radiation therapy?

A

Radiation necrosis may occur after treatment is completed

52
Q

Give examples of chemotherapy drugs

A
53
Q

How are chemotherapy drugs administered?

A

PO (means per os in latin - by mouth)

IV

Intrathecal (spinal injection)

54
Q

What are the side effects of chemotherapy?

A

Bone marrow suppression

Fatigue

Hair loss

Nausea / vomitting

Anxiety

Peripheral neuropathy

55
Q

What type of tumour causes hydrocephalus due to aqueduct stenosis and also overlies the tectum and midbrain?

A

Pineal germinoma

56
Q

What tumour is usually benign

Most common in young children?

A

Low grade pilocytic astrocytomas

57
Q

What tumour cases locked in syndrome?

A

Brainstem glioma

58
Q

Which tumour is most commonly found in the 4th ventricle - median age at diagnosis is also 5?

A

Ependymoma

59
Q

Whch tumour has abundant capillary blood vessels?

A

Haemangioblastoma

It is also associated with retinal lesions

60
Q
A

MBChB - Y2 - Systems - Nervous System (48 decks)

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