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Neuro weeks4-6 - Keith > 31a - Adult Brain Tumors > Flashcards

31a - Adult Brain Tumors Flashcards

1
Q

Which genetic syndrome is associated with glioma and medulloblastoma?

A

Li Fraumeni (Ch.17 , p53 mutation)

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2
Q

Which genetic syndrome is associated with subependymal giant cell astrocytoma?

A

Tuberous Sclerosis (Ch. 9/16, TSC 1/2)

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3
Q

Which genetic syndrome is associated with cortical tubers and glioma?

A

Tuberous sclerosis (Ch.9/16, TSC 1/2)

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4
Q

Which genetic syndrome is associated with glioma of the optic nerve, astrocytoma and glioblastoma?

A

Neurofibromatosis 1 (Ch. 17, NF1)

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5
Q

Which genetic syndrome is associated with pituitary cancer?

A

MEN Type 1 (ch. 11, menin)

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6
Q

Which genetic syndrome is associated with meningioma, schwannoma, and ependymoma?

A

Neurofibromatosis 2 (ch. 22, NF2)

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7
Q

Which genetic syndrome is associated with hemangioblastoma?

A

Von Hippel Lindau (Ch. 3, VHL)

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8
Q

Which genetic syndrome is associated with retnioblastoma?

A

retinoblastoma mutations (ch. 13, RB1)

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9
Q

Which genetic syndrome is associated with bilateral acoustic neuroma?

A

NF2 (ch.22)

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10
Q

Which neoplasms is Li Fraumeni associated with?

A

glioma and medulloblastoma

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11
Q

Which neoplasms is Tuberous sclerosis associated with?

A

subependymal gian cell astrocytoma, corticol tubers, glioma

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12
Q

Which neoplasms is a mutation in Ch. 17, p53 gene associated with?

A

Li fraumeni = glioma and medulloblastoma

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13
Q

Which neoplasms is NF1 associated with?

A

CH 17 mutation. glioma of optic nerve, astrocytoma, glioblastoma

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14
Q

Which neoplasms is NF2 associated with?

A

meningioma, scwhannomma (bilateral acoustic neuroma), ependymoma

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15
Q

Which neoplasms is MEN type 1 associated with?

A

ptiutitary

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16
Q

Which neoplasms is von hippel lindau associated with?

A

hemangioblastoma (ch. 3, of VHL)

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17
Q

Which neoplasms is a mutation in ch. 22 asssociated with?

A

NF2, meningioma, schwannoma, ependymoma

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18
Q

Which neoplasms is a mutation in 9/16 associated with?

A

TSC1/2 - subependymal giant cell astrocytoma, corticol tubers, glioma

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19
Q

Which neoplasms is a mutation in ch 11 associated wtih?

A

MEN1 - menin - pituitary tumors

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20
Q

What is most common type of primary brain tumor?

A

infiltrative astrocytoma and/or Glioblastoma multiforme

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21
Q

Which type of MRI makes water appear white?

A

T2 MRI. CSF, Edema and tumors (water) appear bright. Contrast is dark

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22
Q

Which type of MRI makes contrast appear dark?

A

T2 MRI. Contrast dark, water bright

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23
Q

Which type of MRI will show tumors as hypointense?

A

T1 MRI will show hypointesnse water (CSF, tumor, edema) and bright contrast.

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24
Q

What is the equation for cerebral perfusion pressure?

A

CPP = MAP - ICP

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25
Q

What headache symptoms should clue you in to brain tumors?

A

worse on waking up but better within an hour.
Vomiting immediately after headaches.
New onset or change in character of headaches, or change in mental status

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26
Q

What is gold standard for diagnosing brain tumors?

A

MRI = gold standard
CT is better for calcification/pathology
Tissue biopsy is definitive diagnosis EXCEPT for CNS lymphoma because you can sample malignant cells on LP

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27
Q

Concerning brain herniations, What is contralateral hemianopsia indicative of?

A

Ips. PCA compression

28
Q

Concerning brain herniations, what is ipsilateral dilated pupil and ptosis indicative of?

A

CN III compression

29
Q

Concerning brain herniations, what is ipsilateral paresis indicative of?

A

Contralateral Crus cerebri compression (Kernohan’s notch)

30
Q

What is Duret hemorrhage?

A

caudal displacement of brainstem, commonly causes paramedian artery rupture

31
Q

What is at risk for compression in a cingulate (subfalcine) herniation?

A

cingulate passes under falx cerebri. Anterior cerebral artery at risk for compression.

32
Q

What are symptoms of a diencephalic downward (transtentorial) herniation?

A

brainstem will be compressed so drowsiness, imparied vertical gaze, bilateral small pupils (horner), coma–>death.

33
Q

What should CNIII palsy and both contra/ipsilateral hemiparesis make you think in terms of herniations?

A

classical uncal herniation. May have contralateral or ipsilateral hemiparesis depending on particular case, but always CN III palsy.

34
Q

What are symptoms of upward herniations through the tentorium?

A

ipsilateral occulmotor nerve palsey mixed with horner’s syndrome (so midposition unreactive pupil), contralateral hemiparesis

35
Q

What type of herniation could cause BP and respiratory changes, weakness and horner’s syndrome?

A

cerebellar tonsilar herniation

36
Q

What types of neoplasms are considered gliomas?

A

astrocytomas, oligodendroglioma, ependymoma

GBM

37
Q

What are good prognostic factors for gliomas like astrocytomas or oligodendrogliomas?

A 
MGMT methylation (good band=good prognosis), IDH mutation, Ch. 1/19 deletion in tumor.
Obvious ones like low age, low grade/stage.
38
Q

Where are gliomas most commonly found?

A

cerebral hemispheres

39
Q

Butterfly lesion on MRI = ?

A

butterfly glioma. they like to cross the corpus callosum.

40
Q

GFAP+ astrocytes with pseudopalisading tumor cells around the area of necrosis on biopsy should make you think what?

A

astrocytoma

41
Q

What type of MRI is best for GBM?

A

T2 it will pop up as hyperintense (white).

Will be negative on T1 because it is slow growing, with few vessels and not a lot of leakiness

42
Q

Treatment for gliomas such as astrocytomas, or ependymomas?

A

chemo: temozolomide and bevacizumab.
radiation
steroids to restore BBB (fast and temporary)
anticonvulsants (only after seizures occur)

43
Q

Which are secreting pituitary adenomas: macro or micro?

A 
micro secrete (< 1cm).
macro >1 cm tend to be nonsecreting so they get large and start causing compression symptoms that clue you in.
44
Q

What type of receptor does GH use?

A

JAK/STAT

45
Q

What are symptoms of pituitary microadenoma?

A

galactorrhea from prolactin, acromegally from GH.

46
Q

What are symptoms of pituitary macroadenoma?

A

bitemproal hemaniopsia.
headache
diplopia and facial numbing.

47
Q

What nerves travel in cavernous sinus?

A

5 nerves in the carvernous: 3,4,V1,V2, and 6

48
Q

If lower quadrants of vision are lost, from which side is the optic tract/chiasm being compressed?

A

vision loss on bottom = compression from top = Rahtke pouch craniopharyngioma

49
Q

What is drug treatment for GH secreting tumor?

A

somatostatin analogue octreotide

50
Q

What is drug treatment for prolactin secreting tumor?

A

Dopamine agonist bromocriptine. DA inhibits prolactin secretion

51
Q

EBV infection in an AIDs patient is a risk for what brain neoplasm?

A

CNS lymphoma. Most common CNS tumor in AIDS.

52
Q

Multiple lesions in leptomeninges and deeper periventricular brain parenchyma =

A

CNS lymphoma

53
Q

What is used for diagnosis of CNS lymphoma

A

B cells found in CSF

54
Q

Why should you not give steroids prior to doing an LP?

A

it will mess with results. In CNS lymphoma it will necrose B cells.

55
Q

What are meningiomas derived from?

A

arachnoid cap cells outside the brain (extra-axial)

56
Q

What are the different types of meningiomas?

A

low grade (most common), atypical, and malignant

57
Q

Where are meningiomas found?

A

convexity, parasagittal or optic sheath.

Well defined masses easily separated from neuropil

58
Q

What is microscopic pathology of meningioma?

A

psammoma bodies

59
Q

How will a meningioma appear on MRI?

A

dark on T1, bright on T2.

Calcifications from psammoma bodies or dural tail.

60
Q

Where are acoustic neuroma’s derived from?

A

scwhann cells around vestibular branch of CN 8

61
Q

What does Antoni A and Antoni B mean?

A

for acoustic neuromas. on microscopic path,
Antoni A = densely packed cells
Antoni B = loose cystic areas

62
Q

What is clinical presentation of acoustic neuroma?

A

hearing loss, tinnitus, dizziness, ataxia

63
Q

What is most common source of brain mets?

A

lung cancer (50%), then breast cancer in females.
Melanoma high very high probability of met to brain.
also colon and renal

64
Q

Where are extradural spinal cord tumors from?

A

mets from breast, lung, prostate,

less importantly from renal, lymphoma, sarcoma

65
Q

What are the intradural extramedullary tumors?

A

schwannomas, neruofibriomas and meningiomas

66
Q

What are the intradural intramedullary tumors?

A

astrocytoma in PEDs, ependymoma in ADULTS, hemangioblastomas

Neuro weeks4-6 - Keith (37 decks)

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