Brain tumours Flashcards by Heo Mun Ho

Right handed, woman presents with acalculia, agraphia,
finger agnosia and right/left confusion.
Where would you suspect her lesion to be?

Left parietal lobe

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Left handed, woman presents with ataxia and in-coordination.
Where would you suspect her lesion to be?

Cerebellum

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Right handed, man presents with a bi temporal hemianopia.

Where would you suspect his lesion to be?

Pituitary gland

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Right handed man presented to medical team with cognitive language dysfunction:
difficulty reading e mails
difficulty expressing what he wished to say
short-term memory impairment

Also a 6 week history of posterior rib pain

PMHx included a left nephrectomy for renal cell carcinoma

Where is his suspected lesion

Left temper-parietal area

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Which cranial fossa are GBMs not common in

Posterior

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Woman presented to A&E with decreased level of consciousness

“slowing down”
making uncharacteristic mistakes at work
4 day history of drowsiness
headache and nauseated

GCS 11: e3v3m5
Pupils equal and reactive to light
No apparent focal neurological signs
Mild pyrexia (37.5°C)
Examination of chest/abdomen/breast normal
No palpable lymphadenopathy or skin lesions

What investigation next?

CT/MRI brain

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If symptoms/signs suggest intracranial lesion, DO NOT do what investigation + why

Lumbar puncture because you might cause herniation of cerebellum –> death

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Brain tumours classified into what 2 tumour types

Primary

Secondary

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Name 3 primary brain tumours

Gliomas, e.g. glioblastoma multiforme (GBM) - malignant
Meningioma - usually benign
Pituitary tumour - usually benign

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What are secondary brain tumours

Metastases

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Brain metastases are commonly from what 5 places

Kidney
Lung
Breast
Melanoma (i.e. skin)
Colon

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Gliomas (e.g. glioblastoma multiforme, oligodendroglioma) are derived from what cells

Glial cells - e.g. astrocytes, oligodendrocytes

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Function of astrocytes

Provide structural and nutritional support to neurons

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Meningiomas arise from which layer of the meninges usually

Arachnoid mater

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Pituitary tumours are most of the time what type of tumour

Adenoma

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How do brain tumours affect ICP

Raise ICP

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Focal neurological deficits that brain tumours may present with (5)

Motor weakness - hemiparesis etc
Dysphasia
Visual impairment - hemianopi, diplopia etc
Memory impairment
Cranial nerve palsy

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An early warning sign of a tumour could be…

Seizures

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Symptoms of raised ICP (5)

Headache - usually morning 
Nausea
Vomiting
Visual disturbance - blurry vision etc
Sleepiness

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Signs of raised ICP (5)

Papilloedema - pressure on CN II
CN III palsy --> pupillary dilation
CN VI palsy --> convergent squint --> diplopia
Cognitive decline
Altered consciousness
Hydrocephalus

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Signs of pituitary tumours (2)

Visual disturbance - bitemporal hemianopia (due to compression of optic chasm)
Hormone imbalance

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Investigations of brain tumours (3)

If metastases suspected, what other investigations (5)

CT head
MRI head
PET

CXR
CT chest/abdo/pelvis
Biopsy of skin lesions/lymph nodes

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Treatment of glioblastoma multiforme (5)

Surgical debulking of tumour
\+
Radiotherapy
\+
Chemotherapy - temozolomide

Steroids - dexamethasone
Anticonvulsants - if have seizures

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Treatment of meningiomas

if asymptomatic
if symptomatic (2)
if surgery unsuitable (2)

If asymptomatic - observe

If symptomatic - surgical resection + radiotherapy

If surgery not suitable - radiotherapy/stereotactic radiosurgery (not actually surgery, still radiation)

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Treatment of brain metastases (3)

Steroids, Anticonvulsants Radiotherapy

3 localised lesions/space occupying lesions that cause raised ICP

Haemorrhage Tumour Abscess

Name a generalised (i.e. not localised) lesion that causes raised ICP

Oedema post trauma

Consequences of space occupying lesions leading to raised ICP (3)

Increases amount of tissue in the skull so unstable ICP Internal shift between the intracranial spaces Local ischaemia as tumours squeeze nearby tissue

Internal shift (herniation) between the intracranial spaces can shift in what directions (4)

Right --> left Left --> right Cerebrum can move inferiorly over edge of tentorium cerebelli (tentorial herniation) Cerebellum can move inferiorly down forage magnum (coning)

What is subfalcine herniation (2)

MIDLINE SHIFT: Cingulate gyrus pushed to one side and herniates underneath the falx to the other side So falx cerebri is pushed to one side as well

What is tentorial/uncal herniation (3)

Brain herniates inferiorly over the side of the tentorium cerebelli --> pushing the brainstem medially --> narrowing the cerebral aqueduct

What is cerebellar tonsillar herniation (3)

Tonsils move medially and inferiorly down foramen magnum --> crushing the brainstem --> brainstem death

Grave complication of raised ICP

Brainstem death

Primary brain tumours can be classified by cell of origin - what are the 2 subcategories

Tumours arising from cells inside brain, i.e. neurons or glial cells Tumours arising from cells outside brain

Name 3 main types of gliomas (i.e. tumours arising from glial cells)

Astrocytoma Oligodendroglioma Ependymoma

Name a common astrocytoma

Glioblastoma multiforme

How are astrocytomas graded

``` Low grade (slow growing) High grade (Fast growing) ``` or Grades 1 - 4

What grade astrocytoma is a glioblastoma multiforme

Grade 4

Name a tumour arising from embryonic neural cells

Medulloblastoma (childhood malignant tumour)

Name 5 primary brain tumours arising from cells outside the brain (i.e. not arising from neurons or glial cells)

``` Meningioma Schwannoma Pituitary adenoma Lymphoma Haemangioblastoma ```

What cells do mengiomas arise from

Arachnoid cells

What vessels do haemangioblastomas arise from

Capillaries

Brain tumours in adults are mostly above what fold of dura

Tentorium cerebelli

Brain tumours in children are mostly BELOW what fold of dura

Tentorium cerebelli

Are gliomas encapsulated

Do gliomas metastasise outside CNS

What cells are GBMs derived from

Astrocytes

Histological appearance of low grade astrocytomas (slow growing)

Bland cells, similar to normal astrocytes

Histological appearance of high grade astrocytomas (slow growing)

Large abnormal astrocytes with multiple/irregular nuclei

Histological appearance of meningiomas

Bland cells clustering together --> ARACHNOID GRANULATION Psammoma - calcified clustered cells

Do meningiomas metastasis

Are meningiomas usually being or malignant

Benign

Medulloblastomas affect who most

Children

Medulloblastomas usually found in what fossa + are they usually benign/malignant

Posterior Malignant

Histology of medulloblastomas

Layers of undifferentiated cells

Nerve sheath tumours only affect nerves where

Nerves in the PNS, i.e. peripheral nerves covered by Schwann cells

A common schwannoma is schwannoma of CN VIII - what is it also known as

Acoustic neuroma

Main clinical feature of acoustic neuromas (benign)

Unilateral sensorineural hearing loss

CNS lymphomas are usually lymphomas of what cells

B cells

Haemangioblastomas are most often found where in the brain

Cerebellum

Are schwannomas usually benign or malignant

Benign

What is a psammoma

Calcified cluster of arachnoid cells that can occur with meningiomas

Treatment of pituitary adenomas (3)

Trans-sphenoidal resection of tumour Radiotherapy if there's residual tumour after surgery Hormone replacement

Treatment of acoustic neuroma (2)

Focused radiotherapy (stereotactic radiosrugery) or surgery

Symptoms of a medulloblastoma (Childhood malignant tumour) (4)

morning headaches, nausea/vomiting Visual disturbance - diplopia Behavioural changes

Symptoms/signs of a meningioma (4)

Often ASYMPTOMATIC until large (symptoms come from mass effect) Headache Neurological deficit - visual impairment, hearing/smell impairment, muscle weakness Seizure

Where are acoustic neuromas often anatomically found

At the cerebellopontine angle

Symptoms/signs of astrocytomas, e.g. GBM (7)

``` SEVERE morning headache Nausea/vomiting Visual disturbance - diplopia, visual field cut, visual acuity loss Seizures Motor weakness Dysphasia ```

Can get spontaneous ... without nausea in brain tumours

Vomiting

Symptoms/signs of frontal lobe tumours (4)

Behaviour + personality change Loss of concentration and judgement Memory impairment Headache

Brain tumours Flashcards

(70 cards)