Brain Tumours

Question 1

What headache red flags should make you suspicious about brain tumours?

Answer 1

Worse in the morning

Wakes them up

Worse with coughing and on leaning forward

Associated with vomiting

Question 2

What is the most common type of brain tumour?

Answer 2

Metastases

Question 3

What is the most common type of primary brain tumours in adults?

Answer 3

Astrocytoma (high grade gliomas)

Question 4

What type of brain tumour has a “butterfly” appearance on MRI?

Answer 4

Glioblastoma Multiforme

high grade glioma/ astrocytoma

Question 5

Anaplastic astrocytoma and glioblastoma multiforme are both types of high grade glioma. Which has the worst prognosis?

Answer 5

Glioblastoma multiforme (median survival is <1 year)

Question 6

Give some examples of neuroepithelial tumours

Answer 6

Atrocytomas

Oligodendrogial tumours

Question 7

Give some examples of extra-axial tumours

Answer 7

Meningiomas

Pituitary tumours

Acoustic neuromas

Question 8

Which type of tumour causes a “white toothpaste” appearance when they invade the subarachnoid space?

Answer 8

Oligodendrogial tumours

Question 9

Why is survival higher with oligodendroglial tumours than other gliomas?

Answer 9

They are very chemosensitive

Question 10

What are meningiomas?

Answer 10

Benign tumours of mesenchymal cells

Question 11

There is an increased risk of multiple meningioma in patients with which conditions?

Answer 11

Neurofibromatosis type 2 or PMH of radiation

Question 12

What are ‘meningioma en plaque’?

Answer 12

A subgroup of meningiomas which involve a carpet/ sheet-like lesion that infiltrates the dura and sometimes invades the bone

Question 13

What kind of symptoms do meningiomas cause?

Answer 13

Mostly asymptomatic

May present with headaches and symptoms of raised ICP by compressing the underlying brain

Question 14

Which type of brain tumour originates from arachnoid cap cells in the arachnoid membrane?

Answer 14

Meningiomas

Question 15

Where do oligodendroglial tumours arise?

Answer 15

In the frontal lobes

Question 16

Does the brain have pain sensation?

Answer 16

No, but the skin and dura e.t.c surrounding the brain do

Question 17

What is Foster-Kennedy syndrome?

Answer 17

Optic atrophy in the ipsilateral eye and papilloedema in the contralateral eye

Caused by a meningioma in the olfactory groove
/ or another type of brain tumour occurring in the frontal lobe of the brain

Question 18

What are the size limits for a microadenoma Vs a macroadenoma?

Answer 18

microadenomas < 10mm, macroadenomas >10mm

Question 19

Give some examples of conditions caused by functional pituitary tumours

Answer 19

Acromegaly and Cushing’s disease

*Functional pituitary tumours secrete pituitary hormones

Question 20

How are most pituitary tumours managed?

Answer 20

Transphenoidal hypophysectomy surgery

Question 21

How might a prolactinoma (type of pituitary tumour) present?

Answer 21

Amenorrhoea

Infertility
Loss of libido

Gelactorrhoea
Erectile dysfunction

Question 22

What investigation can be done for a prolactinoma and how is it managed?

Answer 22

Prolactin levels and imaging

Dopamine agonists e.g cabergoline

Question 23

What condition would a GH secreting tumour cause?

Answer 23

Acromegaly

Growth of hands and feet
Carpal tunnel
Diabetes
e.t.c

Question 24

How would acromegaly be investigated and managed?

Answer 24

GH levels after glucose tolerance test

Managed with pegvisomant and somatostatin analogues

Question 25

What condition would an ACTH secreting tumour cause?

Answer 25

Cushing's ``` Central obesity Hirsutism Acne Hypertension Moon face e.t.c ```

Question 26

How would an ACTH secreting tumour be investigated?

Answer 26

Dexamethasone suppression test

Question 27

How would a thyrotropinoma (type of pituitary tumour) present?

Answer 27

``` Palpitations Weight loss Insomnia Anxiety Goiter e.t.c (symptoms of hyperthyroidism) ```

Question 28

How would a thyrotropinoma be investigated?

Answer 28

TSH, T3 and T4 | would all be elevated

Question 29

What tumour is extra-axial and derived from schwann cells?

Answer 29

Acoustic neuroma (aka vestibular schwannoma)

Question 30

Most acoustic neuromas are unilateral, which condition should be considered if the tumour is bilateral?

Answer 30

Neurofibromatosis type 2

Question 31

Verocay bodies can be seen pathologically with which type of tumour?

Answer 31

Acoustic neuroma

Question 32

How might an acoustic neuroma present?

Answer 32

Unilateral sensorineural hearing loss Tinnitus Vertigo Facial pain/ numbness (if trigeminal nerve is involved)

Question 33

What are the risks of operating on an acoustic neuroma?

Answer 33

Facial nerve palsy Nystagmus

Question 34

Hemangioblastomas are benign, highly vascular tumours. Where are they most commonly found?

Answer 34

Posterior fossa

Question 35

Multiple asymptomatic hemangioblastomas are associated with which condition?

Answer 35

Von Hippel-Landau syndrome

Question 36

What 3 bloods should be done to investigate any midline brain tumour in children

Answer 36

ABP, HCG and LDH | suspect pineal tumour

Question 37

Which form of imaging is best to do in children?

Answer 37

MRI | CT has a high dose of radiation

Question 38

What is the risk of post op radiotherapy in children?

Answer 38

Can lower IQ

Question 39

What is the most common primary brain tumour in children?

Answer 39

Medullobastoma

Question 40

How can oligodendrogial tumours be differentiated from astrocytomas?

Answer 40

By the presence of calcification, cysts and peritumoral haemorrhage

Question 41

What clinical signs in children are suggestive of a brain tumour?

Answer 41

Tiptoeing and ataxia