Brain Tumours Flashcards
(102 cards)
1
Q
Children are more likely to get supratentorial/infratentorial tumours?
A
Infratentorial
2
Q
Benign tumours can kill. Why is this?
A
Simply due to their location within the brain
3
Q
Secondary brain tumour - definition
A
Brain mets
often from breast, lung, kidney, thyroid
4
Q
Which is most common: primary or secondary brain tumours?
A
Secondary brain tumours
5
Q
Pathophysiology
A
Since the skull is rigid, if a tumour grows it has nowhere to go.
when a tumour is walnut sized the brain can’t compensate any further and there is a sudden increase in ICP.
6
Q
Warning clinical features of raised ICP
A
Headache Papilloedema (fundoscopy)
7
Q
In adults, most tumours arise from above/below the tentorium cerebelli
A
Above
8
Q
In children, most tumours arise from above/below the tentorium cerebelli
A
Below
9
Q
What is the most common type of tumour in children?
A
Medulloblastoma
10
Q
Clinical features
A
Progressive, focal neurological deficit Headache Nausea and vomiting Motor weakness Seizures Personality changes
11
Q
Clinical features - headache
A
Worse on lying down Worse with coughing Worse leaning forward Wakes patient up at night Worse in the morning
12
Q
Focal neurological deficit - frontal lobe symptoms
A
Contralateral motor weakness (motor strip located here)
Personality changes
Urinary incontinence (Disruption of micturition inhibition centre)
Expressive dysphasia (Broca’s area)
Seizures
13
Q
Focal neurological deficit - temporal lobe
A
Memory deficits Receptive dysphasia (Wernike's area) CN III palsy Blown pupil - unopposed sympathetic supply to the pupil Seizures
14
Q
Focal neurological deficit - parietal lobe
A
Contralateral sensory weakness (sensory strip located here) Dyscalculia Dysgraphia Finger agnosia Left-right disorientation
15
Q
Focal neurological deficit - occipital lobe
A
Visual symptoms
Contralateral homonymous hemianopia
16
Q
Focal neurological deficit - cerebellum
A
Ipsilateral ataxia N+V Intention tremor Slurred speech Dizziness and vertigo
17
Q
Tonsilar herniation - symptoms
A
Cushings triad
- hypertension
- bradycardia
- drop in GCS
18
Q
Tonsilar herniation - emergency management
A
Diuretic (mannitol)
Surgery
19
Q
Investigations
A
Fundoscopy
MRI scan
CT scan
Biopsy
20
Q
First line investigation (and why)
A
Fundoscopy
- looks for papilloedema
21
Q
Management options
A
Surgery
Chemotherapy
radiotherapy
22
Q
Management - chemotherapy
A
Temozolomide
PCV
Carmustine wafers
23
Q
Meningioma - definition
A
Benign
Slow growing
Growth of meninges
24
Q
Which cells does meningioma arise from?
A
Mesenchymal cells
25
Meningioma - extrinsic/intrinsic tumour?
Extrinsic tumour
26
Meningioma usually infiltrates the brain. True or false?
False
27
Patients with neurofibromatosis type 2 are prone to which brain tumour?
Meningioma
28
Histologically benign, well demarcated tumour of the meninges. What is the diagnosis?
Meningioma
29
Meningioma - who gets it?
Elderly patients
Patients with neurofibromatosis type 2
Patients who experienced radiation in childhood
30
Meningioma - clinical features
Mainly asymptomatic
Headaches (due to raised ICP)
CN neuropathies
31
Meningioma - investigations
CT
- densely enhancing oedema
MRI
- patency of dural sinuses
32
Meningioma - management
Angiography +/- embolisation
Surgery
Radiotherapy
33
Meningioma - embolisation. Which arteries can you NOT embolise?
End arteries (eg ophthalmic artery)
34
What is the most common subtype of brain tumour in adults?
Astrocytoma (glioma)
35
Grade 1 glioma/astrocytoma
Truly benign
Low grade
Slow growing
36
Grade 1 glioma/astrocytoma - morphological features
Long hair like processes
| Cystic areas
37
Grade 1 glioma/astrocytoma - mainly affects younger/older people?
Younger
| - children, young adults
38
Grade 1 glioma/astrocytoma - common location in the brain
Cerebellum
39
Grade 1 glioma/astrocytoma - clinical features
```
Progressive headache
Cerebellar involvement
- wide based ataxia
- difficulty speaking (staccato speech)
- intention tremor
```
40
Grade 1 glioma/astrocytoma - investigations
MRI scan
41
Grade 1 glioma/astrocytoma - management
Maximal resective surgery
42
Grade 2 glioma/astrocytoma - truly benign. True or false?
False
- benign but it will become malignant if you wait long enough
- therefore it is classified as pre-malignant
43
Grade 2 glioma/astrocytoma- common in younger/older people?
Younger
| - young adults
44
Grade 2 glioma/astrocytoma - common location
Temporal lobe (most common)
Posterior frontal lobe
Anterior parietal lobe
45
Grade 2 glioma/astrocytoma - grow fast/slow
Slow
46
Grade 2 glioma/astrocytoma - pathology
Cellular and nuclear atypia
47
Grade 2 glioma/astrocytoma - investigations
MRI scan
- early stages this should be normal
- when there is malignant transformation there is enhancement on imaging
48
Grade 2 glioma/astrocytoma - management
Surgery
| - especially if the patient has poor prognostic factors
49
Grade 3 glioma/astrocytoma - definition
```
Anaplastic astrocytoma (malignant)
High grade glioma
```
50
Grade 3 glioma/astrocytoma - pathology
Cellular and nuclear atypia
| Mitotic activity
51
Grade 3 glioma/astrocytoma - what could it progress to?
Glioblastoma multiforme
52
Grade 4 glioma/astrocytoma - definition
Glioblastoma multiforme
High grade glioma
Malignant astrocytoma
53
What is the most common primary CNS tumour?
Glioblastoma multiforme
54
Grade 4 glioma/astrocytoma - more common in younger/older people?
Older (age 60-70)
55
Grade 4 glioma/astrocytoma - pathology
Necrosis
Mitotic activity
Extreme cellular or nuclear atypia
56
Describe the spread of glioblastoma multiforme
Spread via white matter tracts
Spread via CSF pathways
57
Grade 4 glioma/astrocytoma - morphology of tumour
Haemorrhagic
Necrotic
Marked surrounding oedema
Midline shift
58
Glioblastoma multiforme - clinical features
Seizures
Headaches
Bumping into things
59
Glioblastoma multiforme - investigations
MRI scan
- does not uniformly enhance
- areas of necrosis
Biopsy
60
Glioblastoma multiforme - management of choice is curative surgery. True or false?
False
- unable to successfully remove unless it has formed a cyst
- non-curative surgery is the management of choice
61
Pilocytic astrocytoma is an example of a grade 1/2/3/4 astrocytoma/glioma?
grade 1
62
Frontal lobe tumour in young adult. Pathology reveals calcification and toothpaste appearance. What is the likely tumour?
Oligodendroglial tumour
63
Oligodendroglial tumour - common location
Frontal lobe
64
Oligodendroglial tumour - management
Chemosensitive
| - PCV
65
What is PCV triple chemotherapy?
Procarbazine
Lomustine
Vincristine
66
Name 2 examples of nerve sheath tumours
Schwannomas (aka neuromas)
| Neurofibromas
67
Vestibular schwannoma (acoustic neuroma) - most cases are unilateral/bilateral?
Unilateral
68
Bilateral schwannoma + young person makes you think of which diagnosis?
Neurofibromatosis type 2
69
Vestibular schwannoma (acoustic neuroma) - age range
30-50
70
Vestibular schwannoma (acoustic neuroma) - location of tumour
Cerebellopontine angle
71
Vestibular schwannoma (acoustic neuroma) - pathology
Verocay bodies
72
Unilateral sensorineural hearing loss, tinnitus, vertigo, headache, facial pain. What is the likely diagnosis?
Vestibular schwannoma
73
What is the most common type of brain tumour in children?
Pilocytic astrocytoma
| - grade 1 astrocytoma/glioma
74
What is the second most common type of tumour in children?
Medulloblastoma
75
Medulloblastoma - location
Midline of the cerebellum
76
Medulloblastoma - management
Radiotherapy
77
Which investigation scan is favoured in children? MRI or CT ?
MRI
| - lower radiation exposure
78
Child with a "funny face", walking on tip toes, ataxia, developmental delay, vomiting. Where is the likely tumour?
Infratentorial
79
Child with a midline brain tumour. It is known secrete hormones. What is the likely tumour?
Pineal tumour
80
Pineal tumour - which hormones does it secrete
AFP
LDH
Beta HCG
81
Germ cell tumour - more common in males/females?
Males
82
Germ cell tumour - peak incidence age
10-12 years old
83
Which brain tumour is associated with Von Hippel Landau syndrome?
Haemangioblastoma
84
Pituitary tumours - most commonly arise from the anterior/posterior pituitary gland?
Anterior pituitary gland
85
Pituitary tumours - most grow upwards/downwards and press on which structure?
Most grow UPWARDS and press on OPTIC CHIASMA
86
What inhibits prolactin production?
Dopamine
87
Prolactinoma - mechanism
Dopamine inhibits prolactin production.
Tumour can cause loss of dopamine production.
When dopamine is inhibited, more prolactin is produced
88
Prolactinoma - clinical features - female
Galactorrhoea (spontaneous breast milk production)
Menstrual irregularity
Amenorrhoea
89
Prolactinoma - clinical features - male
Lack of libido
Impotence (due to lowered testosterone levels)
Abnormal visual fields
Headache
90
Prolactinoma - investigations
Check prolactin concentration
MRI pituitary
Visual fields
91
Prolactinoma - management
Dopamine agonist (cabergoline)
- lowers prolactin levels
- cause tumour shrinkage
92
Growth hormone secreting adenoma - definition
Acromegaly
93
ACTH secreting adenoma - definition
Cushing's disease
94
Non functioning pituitary adenoma
```
TUmour in the pituitary gland which is not secreting any hormones.
This results in :
- hypoadrenalism
- hypothyroidism
- hypogonadism
- GH deficiency
```
95
Which brain tumour has a characteristic butterfly appearance on MRI?
Glioblastoma multiforme
96
A lesion in which part of the brain is likely to present with contralateral inferior quadrantopia?
Parietal lobe
97
A lesion in which part of the brain is likely to present with contralateral superior quadrantopia?
Temporal lobe
98
Foster kennedy syndrome - how does it arise?
Due to the presence of a meningioma in the olfactory groove
99
Foster kennedy syndrome - how does this present?
Optic atrophy in the ipsilateral eye
| Papilloedema in the contralateral eye
100
A lesion in which part of the brain is likely to present with contralateral homoonymous hemianopia?
Occipital lobe
101
With which tumour can verocay bodies be seen pathologically?
Schwannoma
102
Which lobe of the brain is the micturition centre present?
Frontal lobe
