Space-Occupying Lesions - Intracranial Tumours

Question 1

What are Intracranial Tumours?

Answer 1

Abnormal growths within the brain, varying from benign Meningiomas to highly malignant Glioblastomas.

Question 2

Common Cancers that Metastasise to the Brain (4).

Answer 2

1. Lung.
2. Breast.
3. Renal Cell Carcinoma.
4. Melanoma.

Question 3

Types of Intracranial Tumours (4).

Answer 3

1. Gliomas.
2. Meningiomas.
3. Pituitary Tumours.
4. Acoustic Neuromas.

Question 4

What are Gliomas?

Answer 4

Tumours of Glial cells in. CNS :

1. Astrocytoma - Glioblastoma Multiforme (commonest subtype) - Most Malignant.
2. Oligodendroglioma.
3. Ependymoma - Least Malignant.

Question 5

How are Gliomas Managed?

Answer 5

Grade from 1-4 (1 : Benign - Curable with Surgery; 4 : Malignant).

Question 6

What are Meningiomas?

Answer 6

Benign Tumours growing from cells of the Meninges that can grow and cause a mass effect.

Question 7

Pathophysiology of Meningiomas.

Answer 7

Arise from Arachnoid Cap Cells of Meninges, typically located next to the dura.

Question 8

Clinical Features of Pituitary Tumours (2D).

Answer 8

1. Bitemporal Hemianopia.
2. Hormone Deficiencies - Hypopituitarism or Excess Hormones :
   A. Acromegaly.
   B. Hyperprolactinaemia.
   C. Cushing’s Disease.
   D. Thyrotoxicosis.

Question 9

Management of Pituitary Tumours (4).

Answer 9

1. Trans-Sphenoidal Surgery.
2. Radiotherapy.
3. Bromocriptine : Block Prolactin-Secreting Tumours.
4. Somatostatin Analogues e.g. Ocreotide : Block GH-Secreting Tumours.

Question 10

Epidemiology of Intracranial Tumours (3).

Answer 10

1. Majority of Adult = Supratentorial.
2. Majority of Child = Infratentorial.
3. Commonest : Glioblastoma, Meningioma.

Question 11

Paediatric Intracranial Tumours.

Answer 11

1. Pilocytic Astrocytoma - Commonest.
2. Medulloblastoma - Aggressive.
3. Craniopharyngoma - Supratentorial.

Question 12

Clinical Presentation of Intracranial Tumours.

Answer 12

1. Small = Asymptomatic.
2. Depending on Location = Focal Neurological Symptoms.
3. Raised ICP Symptoms and Signs with Growth.

Question 13

Clinical Features of Raised Intracranial Pressure (6).

Answer 13

1. Headache.
2. Altered Mental State.
3. Visual Field Defects.
4. Seizures - Focal.
5. Unilateral Ptosis.
6. 3rd + 6th Nerve Palsy.

Question 14

Features of Headache in Raised Intracranial Pressure (4).

Answer 14

1. Constant.
2. Nocturnal.
3. Worse on Waking, Coughing, Straining, Bending Forward.
4. Vomiting.

Question 15

Differential Diagnoses of Raised Intracranial Pressure (4).

Answer 15

1. Brain Tumours.
2. Intracranial Haemorrhage.
3. Idiopathic Intracranial Hypertension.
4. Abscesses/Infection.

Question 16

Investigations of Intracranial Tumours.

Answer 16

1. Fundoscopy - Raised ICP.

Question 17

Fundoscopy Changes of Raised Intracranial Pressure.

Answer 17

1. Blurring of Optic Disc Margin.
2. Elevated Optic Disc (retinal vessels curve over raised disc).
3. Loss of Venous Pulsation.
4. Engorged Retinal Veins.
5. Haemorrhages Around Optic Disc.
6. Paton’s Lines (Creases in Retina Around Optic Disc).

Question 18

Management of Brain Tumours (4).

Answer 18

1. Surgery.
2. Palliative Care.
3. Chemotherapy.
4. Radiotherapy.