How do most people with an intracranial tumour present
Progressive neurological deficit - usually motor
Headache
Seizures (less common)
What type of features suggest a headache may be due to a tumour
Worse in the morning or wakes them up
Worse with coughing or leaning forward
Vomiting- headache may feel better after vomiting
- can be v similar to a tension headache or migraine!
What is the most common type of brain tumour
Metastases
What are the signs of raised ICP
headache
vomiting
mental changes
seizures
Why do people get a headache with a tumour?
raised ICP
invasion of dura, blood vessels, periosteum
secondary to diplopia
hypertension- cushings triad
psychogenic - stress due to loss of function
What is cushings triad of raised ICP
a physiological nervous system response to increased intracranial pressure (ICP) that results in Cushing’s triad of increased blood pressure, irregular breathing, and a reduction of the heart rate
What does the frontal lobe control
thought
reasoning
behaviour
memory
MOVEMENT- precentral gyrus
What does the temporal lobe control
behaviour
memory
hearing and vision
emotion
What is controlled in the parietal lobe
intellect
though reasoning memory
SENSATION- post cental gyrus
what does the occipital lobe contol
in a right handed person
left- speech, motor and sensory
right-abstract thoughts
What is a glioma
these are malignant tumours arising from the neuroepithelial tissie
Name the most common tumour arising from neuroepithelial tissue
astrocytomas
what Is an oligodendrogliomas
tumours arising from the oligodendrocytes
- slow growing over many decades
- calcification is common
How are astrocytic tumours grades
1- pleomorphic xanthoastrocytome
2-low grade astrocytoma
3-anaplastic astrocytoma
4-glioblastoma multiforme
what is the pathological hall mark of a glioblastoma
necrosis
What is the prognosis of grade 1 astrocytomas
benign
slow growing
usually in children/young adults
surgery is curative
What is the prognosis of grade 3 and 4 astrocytomas
Poor
2yrs for grade 3, 1 year for grade 4
where are oligodendroglial tumours most commonly found
frontal lobes
how do oligodendroglial tumours typically present
seizures
in adults aged 25-45yrs
What is a collision tumour
oligodendroglial cells coexist with astrocytic cells in a neoplastic collision tumour
What is the prognosis of a low grad oligodendroglial tumour
ten years
What it she mainstay of treatment for oligodendroglial tumours
chemosensitive-
Surgery + chemo
radiotherapy used for seizure decrease but controversial
What is a meningioma
a benign tumour arising from the arachnoid
may grow to a large size over may years
‘extra axial tumours’
usually asymmptomatic
what conditions are menigiomas more common in
breast cancer
NF 2
What are the classifications of menigiomas
classic
angioblastic
atypical- rare
malignant - rare
Name the main nerve sheath tumours
Schwannomas ak neuromas
neurofibromas
malignant peripheral nerve sheath tumours
what is an acoustic neuroma
a vestibular schannoma of the 8th cranial nerve
common in F2
How do acoustic neuromas present
hearing loss
tinnitus
dysequibrium
What age group are predominantly affected by germ cell tumours
less then 20 yrs
How do germ cell tumours metastasise
via CSF
What is the most common CNS germ cell tumour
germinomas
How are germinomas treated
radiosensitive (only give if over the age of three)
good 5 yr survival rate
Name other types of non germinomatous germ cell tumours
teratoma yolk sac tumour choriocarcinom embryonal carcinoma these are all less radiosensitive --> poor prognosis
What tumour markers are present in yolk sac tumours (and teratomas)
Alpha fetoprotein
What tumour markers are present in choriocarcinomas
human choriogonadotropin
(beta-HCG)
also present in germinomas
What is the tumour marker for a germinoma
PLAP - placental alkaline phosphatase
