Tumors of the CNS Flashcards

1
Q

Primary Brain Tumors can arise from what intracranial structures

A

Primary Brain Tumors: coming from the brain itself (ans its strucutres) as opposed to malignancies spreading to the brain

Arising from
- meninges
- neuroepitheliail tissue
- pituitary/related strucutres (endocrine!)
- crainial nerve tumors (like the sheath: schawannoma)
- germ cell tumors

not all brain tumors are malignant!
& braintumors in general are rare

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2
Q

Genetic and Environmental Predispositions for increased risk of Brain Tumors

A

Environmental
- proven: high dose radiation exposure: radiation as a child increases the risk fo head and neck cancer!!!!

Genetic
- Li-Fraumeni Syndrome (multiple CA types inc. risk)
- Neurofibromatosis 1 72 (multiple CA types inc. risk)
- Von Hippel-Lindau disease (multiple CA types inc. risk)
- tuberous sclerosis complex
- cowden
- corlin

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3
Q

most common brain tumor in…
- kids
- adults

A

Kids
- most common = medulloblastoma
- ependymomas
- glioma of BS or optic nerve
- germinoma
- congenital tumor
- astryocytomas

Adults
- meningiomas
- schwannomas (acustic neruoma)
- CNS lymphoma (think immunocomp.)
- Gliomas

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4
Q

how are brain tumors classified

A

Brain tumors will be classified by histopathology and immunohistology

  1. Morphologic features: distored tissue? disrupting others? crossing to other lobes?
  2. growth pattern: rapid? slow?
  3. Molecular profile: identify the type, the response to treatment & the prognosis
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5
Q

what are Gliomas
- originate where
- types

A

Gliomas
- primary brain tumors that originate from brain parenchyma directly: glial cells are those helper cells of the brains!

Symptoms: will vary dramatically depedning on the location

Types of Gliomas
- Astrocytes (most common)
- Oligodendromas
- Glioblastoma multiforme (worst prognosis)
- Ependyoma

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6
Q

What are Medulloblastomas
- what are some key features/symptoms

A

Medullablastomas
- a primary neuroectodermal tumor
- think of these in teh posterior fossa of the brain: squishing
- obstructive hydrocephalus: because its in posterior fossa so its blocking CSF exit!!

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7
Q

Meningiomas
what are they
where
what do they do

A

Meningiomas: tumr of the meningnes
these are BENIGN tumors of the menignes: can form anywhere there is dura

  • symptoms again, will depend on the tumor location
  • these will Compress but will NOT invade the brain parynchyma

key: these are less likely to have seizures as a presenting symptom, more likley to have HA and sensory issues as a result

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8
Q

Clinical Presentation of Pts. with Brain tumors
general v focal symptoms

A

Presentation
General symptoms of all brain tumors = increased intracranial pressure
- HA: severe HA which is WORSE in the morning right when waking up, occasionally related to N/V

Focal Symptoms: due to tissue compression or destruction
- unilateral weakness (since its one side)
- personality changes: especailly if frontal lobe
- cognitive dysfunction: any location can produce this

as tumor increases in size, the focal symptoms progress to more general symptoms

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9
Q

Symptoms: Based on Location

A

Frontal Lobe = dementia, personality changes, seizures, expressive aphagia (cant get words out) & gait disturbances

Parietal Lobe = Receptive aphasia (word salad, cant speak), sensory loss, hemianopia, spatial disorientation

Temporal Lobe = seizures: complex partial or generalized , quadrantonpia, behavior alterations

Occpital Lobe = contralateral hemianopsia

Thalamus = Contralateral sensory loss, behavior changes, langugae disorders

Cerebellum = ataxia, dysmetria(improper coordination), nystagmus

Brainstem = CN dysfunction, ataxia, pupillary abnormalities, nystagmus, hemipareisis, autonomic dysfunction

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10
Q

Patient Presentation

how and when to get imaging? what kind

A

Presentation is not great, a HA with red flag symptoms will clue you in & warrent emergent brain imaging

HA + these symptoms? = get a gadolinum MRI a CT is okay if contrast is contratindicated in MRI (once tumor has been identified, then further imaging will be done)

  • acute, new severe and CHANGING HA from prior
  • fever + HA and other systemic symptoms
  • new HA in adult > 50 (never had it like this before)
  • HA on exertion, onset at night or early AM
  • signs of meningsmus
  • new neurlogic signs
  • pain with valsava (think increase ICP)
  • pregressive HA
  • severe and persisent with other worrisome freatures
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11
Q

Flow chart of how to go about brain tumor

A
  • sus for tumor? = do a MRI with contrast
  • if it is a tumor: malignant or primary
  • malignant? find the source (CT chest, abd, plevis etc.) & biopsy that lesion
  • primary brain? consider brain biopsy to see if CA
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12
Q

how are brain tumors “staged”

A

staging is NOT like other tumors: with T N M grading

these tumors are satge based on histopathological findings and immunohisotolig findigs & imaging

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13
Q

Treatment of Primary Brain Tumors

A

Mainstay of Treatment = surgery: maximal safe resection
- surgery resection dependson location, pt. & age
- postives = histoligca evaluation, relieve mass effect and better survival
- used with adjuct radiation adn chemo

Radiation
- primary or add-on
- standard external beam
- others include: brachytherapy,stereo. etc.
- can improve survival with high risk gliomas
- but watch radiaion SE

Chemo (pediatric tumors more chemo than rad. to reduce risk of expsoure)
- usually given in combo with radiaion
- can have implantable chemo wafer
- deplays progression, doesnt help survival

  • can use a combo of radiation, surgery and chemo
  • management of the sequelae (increase ICP, seizures, etc.)

some just need routine monitoring!

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14
Q

Treating sequaleae of Brain tumor

Increased Intracranial Pressure

A

increased intracrainial pressure = big deal = can lead to airway compromise

  • always protect the airway
  • dextamethasone for increased ICP
  • mannitol for herniation
  • hyperventilation: can temporarilty reduce ICP but less used today
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15
Q

Post-Operative Management
- after surgery or radiation etc.

A

Glucocorticoids: help reduce vasogenic edema and radiation-assocaited edema byt dec. inflammation
- taper after 1 week

VTE prophylaxis: the risk is HIGH for a DVT!!!
- give coumadin or DOACS

Seizure Meds: 30% will have seizure after excision
- prophylatic seizure meds for 1 week after surgery with anticonvulsants (levetiracitam = Keppra)

follow-up MRI 2-3 weeks

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16
Q

Primary CNS Lymphoma
- what is it
- who gets it
- presentation
- diagnosis
- treatment

A

Primary CNS Lymphoma
- commonly B-cell lymphoma

who? = commonly immunocompromised or suppressed like HIV pts.

Presentations
- multiple masses = immunocomp.
- single lesion (immunocompetent)
- meningeal involvement (that spreads into the CSF)

Diagnosis
- MRI and sterotacti biopsy

Treatment
- chemotherapy
- add on rituximab
- whole brain irridation if chemo not able to tolerate

17
Q

Metastatic Intracranial Lesions
- how common
- how do they present

A

10x more common than a primary brain tumor
- these pts. will present with the same as primary tumors: increased ICP, HA and focal/diffused cerebral function

  • often multiple lesions
  • can be the reason to diagnosis the unknown cancer
18
Q

Types of Metastatic Cancers that commonly go to brain
- adults
- kids

A

Adults (lung and breast and melanoma!!!)
- bronchogenic (lung) CA
- adenocarcinomas of breast, thyroid and kidney
- melanoma
- lymphoma

Kids
- neuroblastoma (sympatheitc ganglion tumor)
- ALL: acute lymphoblastic leukemia

19
Q

Management of Malignant CA to brain

A

Management varies based on the Primary Tumor
- a single lesion + healthy pt (realative) = surgery
- radiation (+/- surgery)
- sstemic immunotherapy
- palliative care (melanoma and prostate commonly)

20
Q

Spinal Tumors

Three Locations & tumors that exisit there

A

Locations for Tumor Formation

Intrameduallary (within the SC itself)
- ependymoma
- astrocytoma
- metastisis

Intradural Extrameduallary (in the lining but not int he cord itself)
- meningiomas
- nerve sheath

Extradural: outside the SC
- metatsis
- chodomas
- sarcmoas
- lymphoma
- MM
- benign lesions
- langerhans cell histercytosis

21
Q

Spinal Tumors
Presention
Diangosis

A

Presentation
- Pain: backpain that is gnawing, unremitting and often waking them up at night
- sensory dysthesias
- muscle weakness
- symptoms can begin unilateral & progress to bilateral

PE
- sensory and motor testing to help define location
- can hep show brown sequard syndrome

Diagnosis
- MRI: test of choice
- if cant - CT myelogram

22
Q

Spinal Tumors
Treament of Primary and mets

A

Treatment of Primary
- decompression and surgery
- radiation

Treatment of Mets
- decompression
- radiation

23
Q

Spinal Cord Compression
what is it
symptoms

A

Etiology
- AN ONCOLOGIC EMERGENCY!!!
- commonly a result of a met in the vertebrae eroding into the SC

Symptoms
- pain is first: usually 7 weeks before neuro symptoms
- pain is local to the lesion, worse at night and can be siatic type
- sensory symptoms follow: hyperesthesia that becomes anesthertic below the level
- motor finding follow:leading to proximal muscle weakness that cen become paralysis
- Later findings: bladder and bowel dysfunction and impotence

24
Q

Spinal Cord Compression
Diagnosis
Treatment

A

Diagnosis
- MRI with CONTRAST
- if cant CT myleogram

Management
- opiodids for pain
- steroids!!!
- radiation (good response)
- surgery