Pellico CH 44 CNS Tumors

Question 0

What is the difference between a Benign and Malignant Tumor?

Answer 0

1) Benign - Cells are well differentiated and the tumor is able to be surgically removed.
2) Malignant - Cells are poorly differentiated and or the tumor is not surgically accessible for removal.

Question 1

What is the difference between a primary and a secondary brain tumor? Which is more common and why?

Answer 1

1) Primary - Originates inside the cranium
2) Secondary - Originated outside the cranium (i.e., breast or lung) and metastasized to the the brain. Secondary brain Tumors are more common because they are the result of metastasis of other tumors.

Question 2

What are the 5 different types of gliomas (intracerebral brain neoplasms) and how are they graded?

Answer 2

1) Astrocytomas - Grades I and II
2) Glioblastoma Multiforme - Astrocytoma grades III and IV
3) Oligodendrocytoma - Low and high grades
4) Ependymoma - Grades I to IV
5) Medulloblastoma

Question 3

Which brain tumor is the most common, malignant and aggressive?

Answer 3

Glioblastoma Multiforme (GBM) - Has a poor prognosis

Question 4

Which 3 things are used to grade brain Tumors?

Answer 4

1) Cellular density
2) Cell mitosis
3) Appearance

Question 5

What is an Acoustic Neuroma? What are its SxS? Which tests are used in diagnosis?

Answer 5

1) Acoustic Neuroma (aka vestibular schwannoma) is a benign tomorrow of CN VIII, which is responsible for hearing and balance.
2) SxS include hearing loss, tinnitus, vertigo and a staggering gait.
3) Weber and Rhine tests may mp e useful in assessing asymmetric hearing loss.

Question 6

What is the difference between a Producing and a Non-producing Pituitary Tumor?

Answer 6

1) Non-Producing - Has no effect on hormone production.
2) Producing - Can produce one or more hormones (usually by the anterior pituitary). I.e., prolactinomas, growth hormone secreting tumors causing acromegaly, ACTH secreting hormone causing Cushing’s Disease.

Question 7

What is an Angioma? What is it’s co-relation to strokes?

Answer 7

1) Brain Angiomas are masses composed of abnormal blood vessels that are found in the brain (most often in the cerebellum) or on its surrounding surface.
2) The diagnosis is suggested by the presence of a bruit that is audible over the skull.
3) Because the walls of the blood vessels of the Angiomas are so thin, affected patients are at risk for hemorrhagic stroke. In fact, cerebral hemorrhage in people younger than 40-yrs-old should suggest the possibility of and Angioma.

Question 8

What are the SxS of increased ICP?

Answer 8

1) Headache
2) Nausea with or without vomiting
3) Papilledema (edema of the optic disk)
4) Personality changes
5) Focal deficits (i.e., motor, sensory and cranial nerve dysfunction)
6) LOC changes

Question 9

Late Signs of increased ICP related to vital signs are associated with Cushing’s Triad. What are the 3 components to Cushing’s Triad?

Answer 9

1) Hypertension (with a widening pulse pressure)
2) Bradycardia
3) Bradypnea

Question 10

Where would the patient feel a headache for the following types of tumors:

1) Frontal Tumor
2) Pituitary Tumor
3) Cerebellar Tumor

Answer 10

1) Frontal Tumor - Bilateral frontal headache
2) Pituitary Tumor - Headache that radiates between the two temples.
3) Cerebellar Tumor - Headache in the Sub-occipital region at the back of the head.

Question 11

(T/F) Headaches resulting from ⬆ ICP is most common in the morning, is made worse by coughing, straining and sudden movements, and may improve with vomiting.

Answer 11

True

Question 12

What is the significance of a headache with a fever and a headache without a fever?

Answer 12

1) Headache with a fever - Associated with an infectious process such as meningitis or encephalitis.
2) Headache without a fever - Associated with a tumor or intracerebral bleeding.

Question 13

Which imaging method is considered the gold standard for detecting brain tumors?

Answer 13

MRI

Question 14

What are the 11 listed functions of the Frontal Lobe (Figure 44-2)?

Answer 14

1) Movement
2) Mood
3) Memory
4) Initiative
5) Inhibition
6) Planning
7) Personality
8) Behavior
9) Decision making
10) Judgement
11) Reasoning

Question 15

What are the 5 listed functions of the Temporal Lobe (Figure 44-2)?

Answer 15

1) Hearing
2) Behavior
3) Language comprehension
4) Emotions
5) Memory

Question 16

What are the 5 listed functions of the Parietal Lobe (Figure 44-2)?

Answer 16

1) Calculations
2) Sensations
3) Reading
4) Writing
5) Telling right from wrong

Question 17

What are the 4 listed functions of the Brainstem (Figure 44-2)?

Answer 17

1) Breathing
2) BP
3) Heartbeat
4) Swallowing

Question 18

What are the 3 listed functions of the Cerebellum (Figure 44-2)?

Answer 18

1) Balance
2) Coordination
3) Fine muscle control

Question 19

What are the Early and Late Signs associated with Spinal Cord Compression (SCC)?

Answer 19

1) Early Signs - Bladder and bowel dysfunction (Urinary incontinence or retention and fecal in continence or constipation).
2) Late Signs - Motor weakness and sensory deficit progressing to paralysis.

Question 20

What is the hallmark sign of Spinal Metastasis?

Answer 20

Pain (back)

Question 21

Which position is usually most comfortable for surgical spinal patients and why?

Answer 21

Side laying position, because this position imposes the least pressure on the surgical site.