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Year Two - Neurology System > Brain Tumours > Flashcards

Brain Tumours Flashcards

(104 cards)

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1
Q

What are brain tumours?

A

They are defined as a growth of cells within the brain that multiples in an abnormal, uncontrollable manner

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2
Q

What are the six main classifications of brain tumours?

A

Metastatic Brain Cancer

Gliomas

Meningiomas

Vestibular Schwannoma

Medulloblastomas

Craniopharyngioma

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3
Q

What is metastatic brain cancer?

A

It occurs when cancer cells spread from their original site to the brain

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4
Q

What is the most common form of brain tumour?

A

Metastatic brain cancer

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5
Q

What are the five primary tumour sites that most commonly spread to the brain?

A

Lung

Breast

Colorectal

Melanoma

Kidney

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6
Q

What is the most common primary tumour site that spreads to the brain?

A

Lung

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7
Q

What are gliomas?

A

They are defined as tumours that originate from the glial cells of the brain or spinal cord

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8
Q

What are the three subclassifications of gliomas?

A

Astrocytomas

Oligodendrogliomas

Ependymomas

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9
Q

What are astrocytomas?

A

They are defined as tumours that originate from astrocyte cells

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10
Q

What are the function of astrocytes?

A

They maintain the external environment of neurones by maintaining the correct ion concentration

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11
Q

What are the three subclassifications of astrocytomas?

A

Low Grade Astrocytoma

Pilocytic Astrocytoma

Glioblastoma Multiforme

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12
Q

What are low grade astrocytomas?

A

These are defined as benign tumours that develop from slow growing astrocytes

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13
Q

What are pilocytic astrocytomas?

A

These are defined as benign, paediatric tumours that develop from slow growing astrocytes

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14
Q

What investigation can be used to diagnose pilocytic astrocytomas?

A

Brain biopsy

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15
Q

How do pilocytic astrocytomas present on brain biopsies?

A

Rosenthal fibres (corkscrew eosinophilic bundle)

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16
Q

What are the most common primary brain tumours in children?

A

Pilocytic astrocytoma

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17
Q

What are glioblastoma multiformes?

A

These are defined as malignant tumours that develop from rapidly growing, atypical astrocyte

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18
Q

What are the most common primary tumour in adults?

A

Glioblastoma multiformes

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19
Q

What are the two investigations used to confirm the diagnosis of glioblastoma multiforme’s?

A

CT/MRI scans

Brain biopsy

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20
Q

What are the two features of glioblastoma multiforme’s on an MRI scan?

A

An irregular mass with central necrosis and a rim enhanced with contrast

Periventricular subependymal spread

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21
Q

How do glioblastoma multiforme’s present on brain biopsies?

A

They present as pleomorphic tumour cells with bordering necrotic areas

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22
Q

What are oligodendromas?

A

They are defined as tumours that originate from oligodendrocytes cells

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23
Q

What is the function of oligodendromas?

A

They function to form the myelin sheath around the neurone axons

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24
Q

Are oligodendromas benign or malignant?

A

Benign

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25
Where are oligodendromas usually located?
Frontal lobes of the brain
26
What investigation is used to confirm the diagnosis of oligodendromas?
Brain biopsy
27
How do oligodendromas present on brain biopsies?
They present as calcifications with a ‘fried-egg’ appearance
28
What are ependymomas?
They are defined as tumours that originate from ependymal cells
29
What is the function of ependymal cells?
They line the ventricles of the brain and central canal of the spinal cord where CSF flows
30
Are ependymomas benign or malignant?
Benign
31
Where are ependymomas usually located?
4th ventricle of the brain
32
What clinical feature is associated with ependymomas? Why?
Hydrocephalus These tumours can obstruct the flow of CSF
33
What investigation is used to confirm the diagnosis of ependymomas?
Brain biopsy
34
How do ependymomas present on brain biopsies?
Perivascular pseudorosettes
35
What are meningiomas?
They are defined as tumours that originate from meninge cells
36
What is the function of meninge cells?
They form the membranes that surround the brain and spinal cord
37
What do meningiomas specifically arise from?
The arachnoid cap cells of the meninges, which are typically located next to the dura mater
38
Are meningiomas benign or malignant?
Benign
39
Meningiomas are described as being extra-axial. What does this mean?
This means that these tumours are external to the brain parenchyma
40
What are the four locations in which meningiomas tend to be located?
Falx cerebri Superior sagittal sinus Convexity Skull base
41
What two investigations can be used to confirm the diagnosis of meningiomas?
MRI/CT scan Brain biopsy
42
How do meningiomas present on MRI/CT scans?
They present as well-circumscribed tumours, with a dural tail
43
What is a dura tail?
This is a connection between the tumour and dura mater
44
What are the features of meningiomas on brain biopsies?
Spindle cells in concentric whorls Calcified psammoma bodies
45
What is the second most common primary brain tumour in adults?
Meningiomas
46
What is another term for vestibular schwannomas?
Acoustic neuromas
47
What are vestibular schwannomas?
They are defined as tumours that originate from Schwann cells surrounding the eighth cranial (auditory, vestibulocochlear) nerve
48
What is the function of Schwann cells?
They wrap around peripheral nerves to provide electrical insulation
49
Are vestibular schwannomas benign or malignant?
Benign
50
Where are vestibular schwannomas located? Why?
Cerebellopontine angle This is due to the fact that the eighth cranial nerve is located between the pons and cerebellum
51
What are the four clinical features associated with vestibular schwannomas?
Unilateral Hearing Loss Facial Nerve Palsy Tinnitus Imbalance
52
What genetic condition is associated with bilateral vestibular schwannoma?
Neurofibromatosis type II
53
What two investigations are used to confirm the diagnosis of vestibular schwannomas?
MRI/CT scan Brain biopsy
54
How do vestibular schwannomas present on an MRI scan?
An enhancing mass in the cerebellopontine angle with extension into the internal acoustic meatus
55
What are the two features of vestibular schwannomas on a brain biopsy?
Antoni A/B patterns Verocay bodies
56
What are verocay bodies?
They are defined as accelular areas surrounded by nuclear palisades
57
What are medulloblastomas?
They are defined as tumours that originate from the embryonic cells in the infratentorial compartment
58
What four structures are contained within the infratentorial compartment?
Midbrain Pons Medulla Cerebellum
59
Are medulloblastomas benign or malignant?
Malignant
60
Where do medulloblastomas typically metastasise to?
CSF system
61
Which patient group tend to be affected by medulloblastomas?
Children
62
What investigation is used to confirm the diagnosis of medulloblastomas?
Brain biopsy
63
How do medulloblastomas present on brain biopsies?
Small, blue cells which appear in a rosette pattern
64
What are craniopharyngiomas?
They are defined as tumours that originate from embryonic remnants of Rathke’s pouch in the sellar region
65
What structure arises from Rathke's pouch?
Anterior pituitary gland
66
Are craniopharyngiomas benign or malignant?
Benign
67
Which patient group tend to be affected by craniopharyngiomas?
Children
68
What are the most common paediatric supratentorial tumours?
Craniopharyngiomas
69
What does supratentorial mean?
The upper aspect of the brain
70
What clinical feature is associated with craniopharyngiomas?
Bitemporal inferior quadrantanopia
71
What are the nine clinical features associated with brain tumours?
Nocturnal Headache Headache Worse Upon Waking Headache Worse Upon Coughing/Straining Visual Field Defects Unilateral Ptosis Focal Seizures Hemiparesis Third & Sixth Cranial Nerve Palsies Papilloedema
72
What do the clinical features of brain tumours indicate?
A raised intracranial pressure
73
What is hemiparesis?
It is unilateral weakness of one entire side of the body
74
What does hemiparesis indicate about the location of the brain tumour?
The side affected by weakness will be contralateral to the location of the tumour
75
What is papilloedema?
It is s swelling of the optic disc secondary to raised intracranial pressure
76
Why is papilloedema a clinical feature of brain tumours?
This is due to the fact that the sheath around the optic nerve is connected to the subarachnoid space
77
What investigation can be used to detect papilloedema?
Fundoscopy
78
What are the five features of papilloedema on fundoscopy?
Blurring of the optic disc margin Elevated optic disc Loss of venous pulsation Engorged retinal veins Haemorrhage around the optic disc Paton’s lines
79
What is optic disc elevation?
It occurs when the retinal vessels curve over the raised optic disc
80
What are Paton's lines?
They are radiating lines around the optic disc
81
What is third cranial nerve palsy?
It is defined as decreased function of the third cranial nerve, resulting in paralysis of the lateral rectus muscles and superior oblique muscles
82
What are the five clinical features of cranial nerve palsy?
Ptosis of the superior eyelid Down + out eyeball position No pupillary light reflex Dilated pupil No accommodation
83
In which eye do the clinical features of third cranial nerve palsy present in?
The ipsilateral eye
84
What is sixth cranial nerve palsy?
It is defined as reduced function of the sixth cranial nerve, resulting in paralysis of the lateral recuts muscle
85
What is the clinical feature of sixth cranial nerve palsy?
Medial deviation of the affected eye This means that the eye is unable to abduct
86
What three investigations are used to diagnose brain tumours?
MRI Scan PET Scan Brain Biopsy
87
What is the gold standard investigation used to diagnose brain tumours?
MRI scan
88
Which contrast is commonly used in MRI scans of the brain?
Gadolinium based contrast
89
How do brain tumours generally present on PET scans?
The cancerous growths will uptake more of the radioactive tracer compared to areas of normal tissue
90
What investigation is contraindicated when diagnosing brain tumours? Why?
Lumbar puncture Brain tumours result in a raised intracranial pressure. If a lumbar puncture is conducted in patients who have a raised intracranial pressure, it can lead to herniation syndrome
91
What is herniation syndrome?
It occurs when brain tissue, blood and CSF shift from their normal position inside the skull
92
What are the four management options for brain tumours?
Surgical Management Radiotherapy Treatment Radiosurgery Chemotherapy Treatment
93
What is the first line management option for brain tumours?
Surgical management
94
What are the two surgical procedures used to manage brain tumours?
Partial resection Total resection
95
When are partial resection surgeries used to manage brain tumours?
When brain tumours are located near sensitive areas OR When they are unable to be completely separated from surrounding tissue
96
When are total resection surgeries used to manage brain tumours?
When brain tumours are small and easy to separate from surrounding brain tissue
97
What is radiation therapy?
It uses high-powered energy beams to kill cancer cells
98
When is radiation therapy used to manage brain tumours?
It is usually combined with chemotherapy to treat cancer in cases where patients are unsuitable for surgery
99
What radiotherapy is used when the brain tumour is proximal to sensitive areas within the brain?
Proton radiotherapy
100
What is radiosurgery?
It involves the use of multiple beams of radiation to give a highly focused form of radiation treatment to kill the tumour cells in a very small area The power of each beam is very small, however at the point of the brain tumour where all the beams meet, a large dose of radiation is received to kill the tumour cells
101
What is chemotherapy?
It uses drugs to kill cancer cells
102
When is chemotherapy used to manage brain tumours?
It is usually prescribed adjuvantly in cases of glioma or metastatic brain tumours
103
What are the three chemotherapy agents used to manage brain tumours?
Temozolomide Cisplastin Methotrexate
104
What is the main chemotherapy agent used to manage brain tumours?
Temozolomide

Year Two - Neurology System (25 decks)

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