Brain Tumours Flashcards
(43 cards)
Symptoms of a Brain Tumour
Non-Localising: 1- Apathy 2- Personality change 3- Dementia 4- Drowsiness
Localising
1- Cranial Nerve palsy
2- Seizures : generalized/focal ( usually initial presentation )
- have to differentiate between is seizure to TIA/vasovagal
3- Lobar : ex: if frontal then changes in sensation , temporal for memory/concentration
4- differentiate between new onset neurological symptoms form stress
2/3 of patients with space occupying lesions have which classical symptoms
Due to Raised ICP
1- Headache
2- Papilloedema
3- Vomiting
Maybe mental disturbance : drowsiness, coma , dementia , mild personality change
Presentation of Raised ICP headache due to space occupying lesion
- Headache presented on waking up.
Time: disperses within 1-2 hours , can disappear for days or weeks
Characteristics: not of great intensity, throbbing or bursted - usually dull ache
Exacerbating : aggravated by coughing , sneezing , stooping down or exertion
Relieving: relieved by aspirin , codeine , rest
Occipital headache radiating down the neck can indicate what
Post fossa / CP angle tumour
Explain Vomiting presentation in space occupying lesions with raised ICP and where is vomiting most common
Vomiting :
- projectile with no nausea or warning
- before breakfast , with headache
Common in
- children more than adults
- post fossa tumours than supratentorial tumours
Explain the Papilloedema presentation in space occupying lesions with raised ICP
- Usually asymptomatic
- vision could be affected
- enlargement of blind spot and late peripheral constriction of fields
- Usually intermittent loss of vision rather than steady deterioration : amaurosis
- Attacks could be triggered by getting up from sitting/lying down : in the morning
- sleeping may trigger episodes of vision loss
What is Amaurosis and how does it present with space occupying lesions
Vision loss without apparent lesion affecting eye.
Presentation : Fugal bilaterally and lasting less than 1 minute
What are the 2 main types of Intracranial tumours
1- Primary : arise within the brain , categorized via where they arise from
2- Secondary : metastases from cancer elsewhere in body. Usually lung and breast
What is the most common cancers to metastases to the brain
Lung and breast cancer
What percentage of brain tumours are Primary , and what percent of malignant Brian tumours are Primary
30% of all Brian tumours
80% of malignant brain tumours
Where do Primary Brain tumours originate from and what Is each type of tumour called
3 main glial cell types
1- Astrocytomas : astrocytes
2- Oligodendrogliomas : oligodendrocytes
3- Ependymomas : ependymal cells
What are Diffusely Infiltrating Astrocytomas , Explain different Grades and if surgical excision is possible
Tumours developing from a mass but also diffusely infiltrate normal brain = Precludes complete surgical excision
Grade 2 : slow growing , eventually will progress to malignant. 5-7 years survival
( common in younger people , present with seizures )
Grade 3 : Anaplastic Astrocytoma , higher proliferation rate, mitotically active. 2-3 years survival
Grade 4: Glioblastoma, elevated tumour cell proliferation, endothelial proliferation, vascular supply and necrosis. 12-18 months survival
Explain the treatment of Gliomas ( surgical )
1- Histological tissue is obtained for diagnosis via closed biopsy or open craniotomy
2- Tumour debulking of focal tumours to relieve mass or pressure effect if it is safe to do so
Most brain tumours are Primary or Secondary
Secondary
Most common type of Primary tumours is which ?
Gliomas ( glial cells )
List categories of Primary tumours
1- Gliomas : glial cells
2- Meningiomas : arachnoid cap cells
3- Pituitary adenoma : pituitary cells
4- Schwannomas : arise form intracranial nerves
Imaging modalities to diagnose brain tumours
1- MRI + contrast: shows area of disease in brain ( infiltration )
2-
3-
Imaging modalities to diagnose brain tumours
1- MRI + contrast: shows area of disease in brain ( infiltration ) and leaky vessels in tumour
2- PET scan : sensitive guide to indicate malignancy
Surgery for Brain tumours Complication and risks
1- Post -operative complication may render patient disabled or unfit for subsequent oncological treatment
2- Risk of death <15 , risk of haemorrhage <5% , infection 5 , seizures
Limitations of brain tumours surgery ( 3 )
1- If cortical and subcortical low density presenting with seizures and progressive headache = surgical treatment limited to diagnostic biopsy
2- Low grade thalamic astrocytoma presenting with progressive hemiparesis = surgical treatment limited
3- deep tumour = high risk of defect post operatively
Surgical techniques used to facilitate maximal safe resection of brain tumours
1- Image guidance ( pre-op scans )
2- Real time intra-operative imagine ex: Ultrasound , CT, MRI
3- Tumour fluorescence, patient drinks to helps to visualize malignant gliomas
4- Awake surgery with direct electrical stimulation and speech/physiotherapist monitoring
Post surgical adjacent therapy for malignant gliomas
1- Course of fractionated radiotherapy over 2-6 weeks
2- Temozolomide for Glioblastomas that cause DNA damage in tumour cells
3- Radiotherapy + PCV ( Procarbazine, lomustine, vincristine ) chemotherapy for anapaestic oligodenregliomas
Which type of Astrocytoma doesn’t infiltrate the brain
Type 1 pilocytic astrocytoma
Do Astrocytomas or Oligodenrogliomas have a better life expectancy
Oligodenrogliomas
