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neuro > A25. Signs of tumors of the spine and spinal space > Flashcards

A25. Signs of tumors of the spine and spinal space Flashcards

1
Q

what % of tumor related death are due to primary CNS tumor

A
  • 2 % of tumor related deaths are due to primary
    CNS
    and out of these
  • 85 % are intracranial and
  • 15 % are spinal.
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2
Q

what % of tumors are intracranial VS spinal

A
  • 85 % are intracranial and
  • 15 % are spinal.
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3
Q

Aim of treatment of spinal tumors

A

is to maintain QOL, not only to
prolong the survival.

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4
Q

etiology of CNS tumors

A
  • most common are metastatic tumors, and
  • meningioma,
  • schwannoma
  • ependymoma.
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5
Q

classification of spinal cord tumors

A

by location
* Extradural tumors (55 %)
* Intradural / extramedullary tumors (40 %)
* Intramedullary tumors (5 %)

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6
Q

Extradural tumors - etiology

A
  • Primarily vertebral metastases (solitary or multiple) - mostly in thoracic region
  • Mostly lung, breast, GI and prostate.
  • Also malignant melanoma, lymphoma and multiple myeloma
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7
Q

most common location for extradural spinal cord tumors

A
  • Primarily vertebral metastases (solitary or multiple) - mostly in thoracic region
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8
Q

most common cancers that metastatize to Spinal cord

A
  • lung,
  • breast,
  • GI
  • prostate.
  • malignant melanoma,
  • lymphoma
  • multiple myeloma
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9
Q

Extradural tumors complication

A

Leading to vertebral compression
and paravertebral - epidural spread,
which causes spinal cord or nerve root compression.

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10
Q

Rare extradural tumors

A

● Osteoid osteomas
● Osteoblastomas
● Chondromas
● Schwannoma/Neurofibromas (shape of sandglass growing into thorax or abdomen)
● Hemangiomas

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11
Q

Extradural tumors of spinal cord- symptoms

A

● Pain usually first symptom, and it’s not alleviated by rest
*Radicular pain

● Signs of spinal cord compression, then transverse lesion
● Usually more motor than sensory symptoms (sensitivity of corticospinal tract)
● At diagnosis: paraparesis in 76 % of cases
● Neurological signs in 20-40 %
*Decreases chance of successful surgical intervention

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12
Q

what is usually the first symptom in extradural spinal tumor

A

● Pain usually first symptom, and it’s not alleviated by rest
*Radicular pain

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13
Q

if there are Signs of spinal cord compression in suspicioun of extradural spinal tumor hence it’s a

A

then transverse lesion

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14
Q

are motor or sensory symptoms more in extradural spinal cord tumor?

A

● Usually more motor than sensory symptoms (sensitivity of corticospinal tract)

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15
Q

at diagnosis of extradural tumor , what can be seen in most cases

A

At diagnosis: paraparesis in 76 % of cases

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16
Q

How does presence of neurological signs affect the surgical intervention

A

Neurological signs in 20-40 %
*Decreases chance of successful surgical intervention

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17
Q

paraparesis def

A

partial paralysis of the lower limbs

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18
Q

diagnosis of Extradural tumors

A

● MRI has the main role
● X-ray can detect in 67-85 % of cases - mostly osteolytic lesions (sometimes vertebral collapse)
● CT and bone scan can provide additional information

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19
Q

what can CT detect in extradural tumors

A

67-85 % of cases - mostly osteolytic lesions (sometimes vertebral collapse)

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20
Q

Extradural tumors treatment

A

● Surgical intervention
○ Resolve stability of spine
○ Decompression
○ Improve QOL

● Radiotherapy
○ First choice in SCLC if no pathological fracture or spinal cord compression

● Chemotherapy
○ Depends on primary tumor

● Vertebroplasty (bone cement is injected into fractured vertebra

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21
Q

what is the First choice of treatment in SCLC
if NO pathological fracture or
spinal cord compression

A

● Radiotherapy

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22
Q

when is Vertebroplasty used in extradural tumor treatment

A

In inoperable multiple vertebral metastases to alleviate local pain

(bone cement is injected into fractured vertebra)

23
Q

can chemotherapy be used to treat extradural tumors?

A

Depends on primary tumor

24
Q

Intradural-extramedullary tumors location

A

Located on lateral or posterior surface of the spinal cord

25
Q

Intradural-extramedullary tumors histology

A

Histologically these tumors are
● Neurofibromas/schwannomas (if multiple: Recklinghausen’s disease)
● Meningiomas
● Ependymomas (from filum terminale)
● Lipomas

26
Q

if multiple Neurofibromas/schwannomas what is it called

A

Recklinghausen’s disease

27
Q

Intradural-extramedullary tumors symptoms

A

● Chronic radicular or local pain first (lasting for months)
● Later: signs of nerve root or spinal cord dysfunction

28
Q

later symtpoms of Intradural-extramedullary tumors

A

signs of nerve root
or
spinal cord dysfunction

29
Q
A
30
Q

Intradural-extramedullary tumors treatment

A

● Surgical
● Radiotherapy
(in malignant tumors and some CSF metastases - eg medulloblastoma, ependymoma)
● Intrathecal chemotherapy (in disseminated leptomeningeal lymphoma

31
Q

when is RT used in Intradural-extramedullary tumors

A

● Radiotherapy
* in malignant tumors
* some CSF metastases
eg medulloblastoma, ependymoma)

32
Q

when is Intrathecal chemotherapy used in Intradural-extramedullary tumors

A

in disseminated leptomeningeal lymphoma

33
Q

what are Neurofibromas/Schwannomas

A

Slow growing benign tumors

34
Q

where do Neurofibromas/Schwannomas occur

A
  • occur at any level and usually from posterior nerve roots
  • Either lie entirely within spinal canal or “dumbbell” through intervertebral foramen (“hourglass”) - can present as a mass in thorax or posterior
    abdominal wall.
35
Q

what can present as a mass in thorax or posterior
abdominal wall

A

Neurofibromas/Schwannomas
lie entirely within spinal canal
or “dumbbell” through intervertebral
foramen (“hourglass”)

36
Q

where are Neurofibromas/Schwannomas found in spinal cord

A

lie entirely within spinal canal or “dumbbell” through intervertebral
foramen (“hourglass”) - can present as a mass in thorax or posterior
abdominal wall.

37
Q

Neurofibromas/Schwannomas-
If suspicion of Von Recklinghausen’s disease

A

look for café au lait spots
in skin

38
Q

Meningiomas- age and gender

A

elderly, and more common in females

39
Q

Meningiomas location

A

Usually arise in thoracic region and are almost always intradural

40
Q

what are Meningiomas

A

Slow growth - considerable cord flattening can occur before symptoms occur

41
Q

what can happen to spinal cord in meningiomas before symptoms occur

A

considerable cord flattening can occur before symptoms occur

42
Q

Meningiomas diagnostics

A

MRI or CT myelography will identify lesion

43
Q

Meningiomas treatment

A

Operative aim is complete removal

44
Q

Intramedullary tumors are characterised by

A

signs of slowly progressing transverse lesion

45
Q

Intramedullary tumors types

A
  • ⅔ of intramedullary tumors are ependymomas (mostly adults) or astrocytomas (mostly children),
  • hemangioblastomas
  • lipomas
  • metastases
  • or dermoid/epidermoid teratomas
  • lymphomas .
46
Q

most common intramedullary tumor in children

A

astrocytomas (mostly children),

47
Q

most common intramedullary tumor in adults

A

ependymomas (mostly adults)

48
Q

Intramedullary tumors symptoms

A

● Reduced pain and temperature sensation below lesion (interruption of lateral spinothalamic tract)

● Lack of radicular pain
● Tumor in conus medullaris
*Cause “saddle type” hypesthesia and autonomic disturbances

● If involving anterior horn cells: LMN involvement in corresponding muscle group
● If involving corticospinal tract: UMN weakness in muscles below lesion

49
Q

intramedullary tumor

what tumor can cause saddle type hypesthesia and autonomic disturbances

A

● Tumor in conus medullaris
*Cause “saddle type” hypesthesia and autonomic disturbances

50
Q

intramedullary tumor involving anterior horn cells causes

A

LMN involvement in corresponding muscle group

51
Q

intramedullary tumor involving corticospinal tract causes

A

UMN weakness in muscles below lesion

52
Q

Intramedullary tumors treatment

A
  • Surgical (maily)
  • radiotherapy (in malignant lesions such as malignant glioma
53
Q

when is radiotherapy used in treatment of intramedullary tumors

A

in malignant lesions such as malignant glioma

neuro (32 decks)

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