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Brain and Behavior Exam 3 > Lec 63 CNS Tumors > Flashcards

Lec 63 CNS Tumors Flashcards

1
Q

What causes localizing symptoms of brain tumors?

A

those caused by tumor invasion or compression of particular structures

ex: aphasia, weakness, visual field cut, seizure, etc

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2
Q

What causes non-localizing symptoms of brian tumors?

A

elevation in ICP due to mass itself, cerebral edema, or hydrocephalus secondary to obstruction

ex: N/V, headache, mental status change

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3
Q

What is most common location of tumors in adults vs children?

A 
adults = supratentorial
kids = infratentorial
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4
Q

What is mainstay of tumor therapy?

A

surgical resection

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5
Q

What are glial tumors [gliomas]? 3 types?

A

tumor of glial cells

  • astrocytomas [malignant or not]
  • ependymoma
  • oligodendroglioma
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6
Q

What is most common type of primary brain tumor [glial or non-glial]?

A

glial = 80%

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7
Q

Where are gliomas usually located?

A
  • frontal lobe
  • insula
  • parieto-occipital region
  • splenium of corpus callosum
  • thalamus
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8
Q

What is glioblastoma multiforme [GBM]?

A
  • grade 4 astrocutyoma
  • common, highly malignant primary brain tumor
  • 1 year median survival
  • found in cerebral hemisphere; can cross corpus callosum = butterfly glioma
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9
Q

What are the 4 grades of glioma called?

A 
grade 1/2 = low grade
1 = fibrillary astrocytoma
2 = astrocytoma or oligodendroglioma
3 = anaplastic astrocytoma / oligodendroglioma
4 = GBM
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10
Q

What is treatment for glioma?

A

supportive care, surgery, try chemo/radiation

prognosis = < 1 year

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11
Q

What are risks for glioma?

A

age, male, ionizing radiation

3 pks of incidence: children, 30-40 yrs, > 65 yrs

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12
Q

What are symptoms of glioma?

A

increased ICP, seizures

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13
Q

What is life expectancy for low grade astrocytoma?

A

5 yrs

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14
Q

What is hemangioblastoma? where is it usually?

A

usually cerebellar

fried egg appearance

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15
Q

What is ependymoma? where is it usually?

A

usually in spaces of posterior fossa but also can be in spinal cord or region of cauda equina

most frequentyl in children/young adults

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16
Q

What are signs of infratentorial ependymoma?

A

N/V, headahce, other signs related to hydrocephalus, CN signs and symptoms

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17
Q

What is pathology of oligodendroglioma?

A

fired egg; chicken wire capillary pattern

often calcified

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18
Q

Where are ependymomas commonly found?

A

in 4th ventricle

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19
Q

What is prognosis of ependymoma?

A

poor prognosis, associated wtih hydrocephalus

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20
Q

What are characteristic pathologies of ependymoma?

A

characteristic perivascular rosettes, rod shaped blepharoplasts [basal ciliary bodies] near nucleus

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21
Q

Are ependymomas more frequently seen in children or adults?

A

children

22
Q

What are characteristics of glial choroid plexus tumors?

A
  • only tumors causing hydrocephalus by over-secretion of CSF rather than blockage
  • classified as papillomas [benign] or carcinomas [malignant]
    more common in childhood
    most foten occur in 4th ventricle
23
Q

What are signs of choroid plexus glial tumors?

A

high ICP [N/V, headache, lethargy], hydrocephalus [excess CSF], deficit eye movement due to pressure on roots of 3, 4, or 6

24
Q

What are characteristics of meningiomas?

A
  • second most common brain tumor
  • arise from meninges
  • typically benign primary tumor
  • often asymptomatic
  • may present with seizure or focal neurological signs, loss of small [if in olfactory groove]
25
Q

What are risk factors for meningioma?

A

female, radiation, neurofibromatosis

26
Q

What is pathology of meningioma?

A

dural tail = attachment to dura
extra axial = external to brain parenchyma
psammoma bodies and whorls of cells

27
Q

What is treatment for meningioma??

A

resect if symptoms present, may need radiosurgery

28
Q

What type of tumor should you think: pseudopalisading

A

glioblastoma

29
Q

Where do meningiomas most often occur?

A

convexities of hemispheres near surface of brain and parasagittal region

30
Q

What age group gets meningioma?

A

age 50-70 but grows slowly

31
Q

What are characteristics of pituitary adenoma? what is most common type?

A

most common = prolactinoma

present with: bitemporal heminaopia due to pressure on optic chiasm, hyper or hypo pituitarism

32
Q

Who commonly gets craniopharyngioma?

A

young children

33
Q

What is a cranipharyngioma?

A

benign childhood tumor
may be confused with pituitary adenoma b/c both can cause bitemporal hemianopia

derived from remnants of rathke pouch, calcification common

34
Q

What are characteristics of medulloblastoma?

A

highly malignant common childhood tumor
usually cerebellar tumor = get vermal symptoms and obstructive hydrocephalus
form of primitive neuroectodoermal tumor
can compress 4th ventricle

35
Q

what are symptoms of pituitary tumors?

A

hyperprolactinemia [lactating, gynecomastia] or acromegaly [gigantism in children]

36
Q

What is pathology of medulloblastoma?

A

homer-wright rosettes
sold [gross]
small blue cells

37
Q

What is non-glial hemangioblastoma?

A

syndromic and hereditary = von hippel lindau [mut in tumor suppressor gene VHL]
can secrete erythropoietin
usually originates cerebellum
treated with embolization then surgery

38
Q

what are characteristics of primary cerebral lymphoma?

A

associated with HIV, immunosuppression, EBV
primary B cell lymphoma
steroid sensitive + treated with chemo/radiation
often have cognitive impairment and poor outcome

39
Q

Where do brain metastases usually come from?

A

lung > breast > melanoma, GI, renal

spread via blood

40
Q

Are metastases infra or supratentorial?

A

supratentorial

41
Q

How does subfalcine herniation present?

A

headache and as progresses –> contralateral leg weakness

42
Q

How does transtentorial [central] herniation present?

A

pupils and respirations change depending on how far down brain it herniates

can lead to stupor, coma

  • pupil irregular then fixed at midposition
  • oculocephalic movements difficult
  • extensor posturing spontaneously
  • motor tone increased
43
Q

What are signs of uncal herniation?

A

contralateral hemiparesis
CN III palsy [dilated pupil]
duret hemorrhages
can lead do decrease level of consciousness

44
Q

What should you think if you have dilated pupil in absence of decreased consciousness?

A

NOT uncal herniation

45
Q

What is kernohan’s notch?

A

sign of severe uncal herniation

causes false localizing sign = large mass effect pushes midbrain against opposite side of tentorium –> paradoxical hemiparesis ipsilateral to lesion instead of contralateral

CN3 still on ipsilateral leg: use pupil dilation > hemiparesis to localize the lesion

46
Q

What are signs of tonsillar herniation?

A

cerebellar tonsils move down through foramen magnum –> compression of medulla oblongata and upper cervical spinal cord

may cause cardiac and respiratory dysfunction

47
Q

What is vasogenic edema? cause?

A

breakdown of tight endothelial junctions [BBB]

due to: trauma, tumors, focal inflammation

48
Q

What is cytotoxic edema? cause?

A

BBB intact –> problem in cellular function [NA/K pump]

seen in reyes syndrome, hypothermia, altitude, psuedomotor

49
Q

What is interstitial edema?

A

seen in obstructive hydrocephalus

due to impairement in BB with transependymal flow of CSF

50
Q

What is osmotic edema?

A

impaired osmolality of blood

Brain and Behavior Exam 3 (32 decks)

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