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Neurology Week 3 2018/19 > 2: Intracranial neoplasms > Flashcards

Flashcards in 2: Intracranial neoplasms Deck (34)
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1

  Which eye sign should be checked for on fundoscopy of someone with a headache?

Papilloedema

indicates CN II compression due to raised ICP, will progress to visual loss if untreated

2

Children tend to get ___tentorial tumours.

What gait do they present with?

infratentorial tumours

ataxic gait, tiptoeing

3

Brain tumours are common in which population?

Children

Second most common cancer after leukaemia

4

What are some of the symptoms of an intracranial tumour?

Headache

N&V

Seizures

Visual disturbance

Sensory / motor problems

Neurological deficit - changes in behaviour, personality, language

5

What is the Monro Kellie hypothesis?

Cranial vault has a fixed volume

So anything that reduces that volume (e.g tumour, bleeding, infection) will cause an INCREASE IN INTRACRANIAL PRESSURE (ICP)

6

What happens to the brain if intracranial pressure increases?

Compression (causing neurological symptoms)

Extreme compression causes herniation

7

What is Cushing's triad of signs following a severe brain herniation?

Why is it important?

Hypertension

Bradycardia

Irregular breathing

If untreated, patient will die imminently

8

What are red flag headache symptoms which may indicate a brain tumour?

New onset in patients aged > 55

Early morning headache

Headaches which interrupt sleep

Unexpected weight loss

Hx malignancy, immunosuppression

9

Does the brain have any pain receptors?

No

10

Do the meninges have any pain receptors?

Yes

e.g photophobia, which is caused by meningeal irritation

11

What are some examples of neurological deficit caused by brain tumours?

Diplopia - double vision

Speech problems - articulation/comprehension

Perseveration - repeating an action or word after a stimulus has stopped

Dyspraxia - lack of coordination

Neglect - inability to see anything in a visual field; see "the man who fell out of bed"

12

Which systems must you examine in someone presenting with new onset neurological symptoms?

Full neurological examination

Eyes - i.e direct fundoscopy, visual acuity, fields, eye movements...

13

What do MRI scans pick up compared to CT scans?

Blood

plus they're higher definition

14

What are three important investigations for intracranial tumours?

CT/MRI scan

Biopsy

Fundoscopy

15

Cancers of astrocytes are ___ depending on their severity.

graded

16

Grade I astrocyte tumours mostly affect which population?

Children

17

All astrocytomas graded II or above are ___.

malignant

18

How are grade I astrocytomas treated?

Surgery

19

What do grade I astrocytomas look like on MRI?

Solid

Enhance well (glow white)

20

What condition may brain tumours cause if they block the flow of CSF around the ventricles?

Hydrocephalus

21

Patients with low grade (II) astrocytomas tend to present with which symptom?

Seizures

22

Do low grade (II) astrocytomas enhance well on injection of contrast?

No

23

Low grade (I.e II and III) astrocytomas will ___ over time unless they are removed surgically.

grow

24

How are grade II astrocytomas treated?

Surgery

+/- chemo/radiotherapy, often combined

25

Which grades of astrocytomas are definitely malignant?

III and IV

26

What is a grade IV astrocytoma called?

Can they be removed surgically?

Glioblastoma

Usually no

27

Who needs to be informed if a patient has visual problems or seizures?

DVLA

28

What treatments can be used for patients who have brain tumours unsuitable for surgery?

Radiotherapy

Chemotherapy

29

Which grades of astrocytomas are classed as

a) malignant

b) benign

c) 'low grade'?

a) III and IV

b) I

c) II

30

Which cells produce myelin in the CNS?

Oligodendrocytes