What is dysmetria
the ataxia on a finger-to-nose test. esp if worse on one side
Many symptoms of brain tumors mimic everyday illnesses, What are red flags?
peristent pattern of HA, involvement of cranial nerves and/or cerebellar in nature. Often involving facial nerves.
What is papilledema and what does it mean
swelling of optic nerve on opthal exam - thought to be a classic brain tumor symptom, but may not be present
CT vs MRI for suspected tumor?
CT is easier, cheaper and good for bleeds and hydrocephalus. If anythiing is seen on it, then MRI is the gold standard for visualizing tumors.
Why is MRI spine needed once a brain tumor is identified?
to look for mets. Ideally done before surgery (if not, wait 14 days to obtain because there could be residual blood in CSF which can mask or show up as a tumor)
What is the usual treatment for brain tumor?
Surgery ASAP. then radiation is the primary tx, and chemo (chemo is becoming more standard)
What is posterior fossa syndrome?
‘cerebellar mutism’ occurs 24-48 hrs post-op. mutism, dysphagia, hemiparesis and irritability. Often emotionally labile, irritable, etc.
Usually transient lasting 2-6 months.
If you suspect posterior fossa syndrome, what should you get?
swallow study to eval aspiration risk and rehab services. Dex, anticonvulsants and mood stabilizers may help.
What percentage of childhood cancers are primary brain tumors? Adult?
30% children, less than 2% adults
Most common locations of child brain tumors?
What is the most common malignant tumor?
What age group should have head circ plotted?
up until 4yo
Are seizures a more common presenting symptom in adults or peds brain tumors?
Adults because more of them are supratentorial. Most children have infratentorial which is less likely for seizures. 10-15%
Where do astrocytoma/gliomas arise?
(used interchangeabley) They are from the glial cells, which are the support cells, so they can be anywhere.
What are the other grades of gliom
What are the other grades of glioma? 1-4
Grade 1 tumors are also known as pilocytic astrocytoma (PCA) or juvenile pilocytic astrocytoma (JPA). Optic glioma can be grades 1-2. Grade 2 tumors are also known as fibrillary astrocytoma. Grade 3 is known as an anaplastic astrocytoma and grade 4 is a glioblastoma multiforme (GBM). Even in children, most high grade glioma tumors are supratentorial.
What is the prognosis for high grade vs low grade glioma? What is treatment in general?
High-grade tumors are always treated with surgery and XRT. Chemotherapy overall has been less effective until recent years when newer drugs have been developed. In young children or in recurrent disease, high-dose therapy with HPCT or stem cell supported therapy may be used. Overall prognosis still remains dismal, especially for GBMs. (less than 25%)
Low-grade tumors in general are usually treated only with surgery. Radiation and/or chemotherapy may be used in recurrent or multifocal tumors. The prognosis for survival is excellent (95%) ; the prognosis for QOL and residual neurologic deficits is related to location and can be minimal to severe.
Where does JPA usually occur? What age? What treatment?
80% in the cerebellum. Usually school age. Treatment is usually surgery only. maybe radiation. Prognosis is 85-95.
Most common brain tumor with NF1?
When does optic glioma usually present?
less than 5 years.
Pt has diabetes insipidus and nystagmus. What tumor is likely?
Optic glioma. Located near the hypothalamus and can be very large, causing SIADH or DI. Hard to notice visual deficits in that age group so it often presents as nystagmus or esotropia
What is esotropia?
a form of strabismus, both eyes inward
What percentage of childhood brain tumors are medulloblastoma/PNET? (used interchangeably)
(sidenote - The terms “PNET” and “medulloblastoma” are often used interchangeably. In the past, the term “medulloblastoma” was used to designate when the tumor occurred in the cerebellum and “PNET” for locations outside the cerebellum. Current terminology generally refers to both tumors as PNETs, and they are classified as small round, blue cell tumors. )
Who has the better survival rate, infratentorial or supratentorial PNET?
supra has worse survival rate. much more common in men. unlike most brain tumors, it can spread to the spine, bones, and other brain areas.
Which type of tumor, unlike most, can spread to the spine, bones/marrow and other parts of the brain?
What is the treatment for a PNET? What is average risk vs high risk?
surgery, XRT and chemotherapy. No XRT if under the age of 3. Average risk when GTR has less than 1.5 cm residual tumor and no other evidence. High risk if spread or not a successful GTR and requires more aggressive therapy.
What is the general prognosis for brain stem glioma? What are treatment options?
very poor - usually present with rapid neuro issues in school age kids. surgery doesn’t help. Chemo and steroids can help, but not much. less than 5% long term survival. Usually 1-2 years from diagnosis to death.
Where are the ependymal cells?
they line the ventricles of the brain and the central canal of the spinal cord.
Where to ependymoma’s show up?
where the ependymal cells are (ventricles and spinal cord) they are invasive and spread to CNS tissue. so usually intracranial, but sometimes primarily in the spinal cord. this is actually the most common to show in the spinal cord.
What is the prognosis and treatment for ependymomas?
40-60%. surgery and radiation. chemo does not often help, unless using it to delay radiation in very young children. can relapse years later.
Why are craniopharyngiomas ‘malignant’?
Location. Right by the pituitary gland, optic chiasm, and hypothalamus.. cure right is high but the deficits are very significant. usually treat with surgery, 75% long term survival.
What is the incidence of primary CNS tumors of spinal cord? Most common in…?
3-6%. most common in teenagers.
What are the 3 main types of metastatic spinal cord tumors?
PNET, ependymoma, astrocytoma
What is the usual treatment for spinal cord tumors?
surgery. PNETS will also get chemo.
What percent CNS rumors are infratentorial? Give 3 examples
- Like cerebellar astrocytomas, medulloblasgomas and ependymomas
What percent of CNS rumors are supratentorial? Give 4 examples
- Astrocytomas, hypothalamic and optic pathway, and craniopharyngiomas
Treatment for low grade astrocytoma?
GTR and surveillance, low recurrence. If not able to get GTR may need chemo or radiation. Or more surgery
Tx for low grade astrocytomas of the brain stem?
Surgical debunking but needs radiation, if younger than 3 then chemo
Treatment for high grade astrocytoma
Poor prognosis. GTR and chemo and radiation. maybe stem cell transplant
Treatment for medullo?
Resection. Then chemo/radiation if there are mets or positive CSF.
Prognosis for medullo?
Where are most ependymomas
Treatment for ependymomas
Hard to get GTR. If done, just surveillance. If not, or recurs, then radiation with possible chemo
Overall survival for spinal cord tumors? Which is the worst one?
90% are not fatal - high grade astrocytoma is pretty devastating
Treatment for most spinal cord tumors
Radiation or surgery. Ependymomas are easier to remove surgically. Chemo not as helpful