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Brain tumours Flashcards

1
Q

What is a brain tumour?

A 
Growth of cells
Benign or malignant
Primary or secondary 
Supra or infratentorial 
Extrinsic or intrinsic
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2
Q

What are common presentations for brain tumours?

A

Progressive neurological deficit
Motor weakness
Headache - raised ICP
Seizures

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3
Q

What can result in an increased ICP?

A

Contribution of mass within a rigid closed box
Tumour/ mass/ oedema mass effect
Hydrocephalus
Haemorrhage

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4
Q

What are symptoms of increased ICP?

A

Headaches
Vomiting
Mental changes
Seizures

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5
Q

What are different types of herniation?

A

Coning; tonsillar herniation
Uncal herniation
Subfalcine

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6
Q

What is cushing’s reflex?

A

Hypertension
Bradycardia
Respiratory depression

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7
Q

What occurs with an uncal herniation?

A

Ipsilateral blown pupil as the herniation presses on the 3rd CN (can also get down and out pupil)

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8
Q

What is a bad sign with headaches?

A

If it wakes you up in the morning or worse in the morning

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9
Q

What should be done immediately with a headache worse in the morning?

A

FUNDOSCOPY to look for papilloedema

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10
Q

Why will increased ICP result in vomiting?

A

Increased pressure on the medulla

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11
Q

Will a headache associated with increased ICP get better or worse on coughing and leaning forward?

A

Worse

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12
Q

What should be given immediately if cushing’s triad is present?

A

Mannitol

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13
Q

Where should you look if there are metastases in the brain?

A

Testes
Breasts
Melanoma (moles, subungal)
Axillary freckling for NF1

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14
Q

What are tumours of the neuroepithelial tissue?

A 
Astrocytes
Oligodendroglial cells
Ependymal cells/ choroid plexus
Neuronal 
Pineal 
Embryonic  - AFP, LDH, b-hcg
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15
Q

What is a grade 1 astrocytic tumour?

A

Pilocytic
Pleomorphic xanthoastroytoma
Subependymal glial cell

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16
Q

What is a grade 2 astrocytoma?

A

Low grade

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17
Q

What is a grade 3 astrocytoma?

A

Anaplastic astrocytoma

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18
Q

What is a grade 4 astrocytoma?

A

Glioblastoma multiforme

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19
Q

Describe a grade 1 astrocytoma

A

Benign
Slow growing
Children and young adults
Cerebellum affected

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20
Q

How are grade 1 astrocytomas treated?

A

Surgery

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21
Q

What are poor prognostic factors associated with low grade astrocytomas?

A 
Age over 50 
Focal deficit
Short duration of symptoms
Raised ICP
Altered consciousness
Enhancement on contrast studies
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22
Q

What is the treatment of a grade 2 astrocytoma?

A

Surgery +/- radio and chemo

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23
Q

What will low grade astrocytomas commonly present with?

A

Seizures

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24
Q

What is the median survival for an anaplastic astrocytoma?

A

2 years

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25
What is the median survival for a glioblastoma multiforme?
14 months
26
Where will a GBM spread?
White matter tracking through corpus callosum and corticospinal tracts
27
What should you think about if there are multiple gliomas?
NF Tuberous sclerosis PML (Progressive multifocal leukoencephalopathy)
28
What is the treatment for GBM?
Non curative surgery to reduce mass effect Post-op radiotherapy If MGMT promoter myelination; should get treatment with oral alkylating chemotherapy
29
What will a GBM look like on MRI?
Heterogeneously enhancing SOL with areas of necrosis and a butterfly appearance
30
What is the grading of gliomas based off?
Cellular and nuclear atypia Mitotic activity Vascular endothelial proliferation Necrosis
31
What do pilocytic astrocytomas look like pathologically?
Bipolar cells with long hair like projections
32
What are common sites for pilocytic astrocytomas?
Cerebellum | Midline; thalamus or optic chiasm
33
Where will oligodendrocytes grow?
Frontal lobe of cerebral hemisphere and can affect white matter and cortex
34
From what cell type will meningiomas grow?
Arachnoid cap cells in the arachnoid membrane
35
What is Foster Kennedy Syndrome?
Optic atrophy in ipsilateral eye and papilloedema int he contralateral eye
36
What are the common presentations of meningiomas?
Headache | Increased ICP
37
What are the clinical features of a prolactinoma?
``` Amenorrhoea Infertility Galactorrhoea Loss of libido ED ```
38
How are prolactinomas treated?
Dopamine agonist; cabergoline | Basically never operated on
39
What are the clinical symptoms of a growth hormone secreting tumour?
Pre-puberty: gigantism | Post-puberty: acromegaly
40
What tests should be run in the diagnosis of acromegaly?
Growth hormone levels IGF-1 levels OGTT
41
What tests should be run to diagnose cushing's disease?
Low dose dexamethasone test to confirm cortisol excess High dose dexamethasone test to differentiate between adrenal or pituitary causes (high dose will suppress cortisol if the source is pituitary)
42
How are pituitary tumours operated on?
Transsphenoidal hypophysectomy
43
What is the medical management of a growth hormone secreting tumour?
Pegvisomant and a somatostatin analogue such as octreotide to shrink the tumour pre surgery
44
What is the treatment of pituitary tumours if they are too large or are invading the cavernous sinus?
Radiotherapy
45
What is a vestibular schwannoma?
Benign tumours of schwann cells at the cerebellopontine angle affect the vestibular portion of CN8
46
What are the symptoms of a vestibular schwannoma?
``` Unilateral: Tinnitus Vertigo +/- headache +/- facial numbness ```
47
What does a bilateral vestibular schwannoma indicate?
NF2
48
What do vestibular schwannomas look like histologically?
Verocay bodies which are palisading nuclei against a fibrillary background
49
What is a haemangioblastoma?
Benign, cystic, highly vascular tumour
50
Where do haemangioblastomas originate?
Posterior fossa - resulting in cerebellar dysfunction and increased ICP
51
What conditions are haemangioblastomas associated with?
``` VHL: Haemangioblastoma Retinal angioma Renal cell carcinoma Phaeo ```
52
Describe an upper motor neurone lesion
``` Hypertonia Hyperreflexia Spasticity +ve babinski sign Clonus ```
53
Describe a lower motor neurone lesion
``` Hyporeflexia Hypotonia Flaccid muscle weakness Fasciculations Muscle atrophy ```
54
How will children commonly present with brain tumours?
Tiptoeing Ataxia Vomiting with headache
55
What occurring in childhood will increase the risk of developing a meningioma as an adult?
Radiotherapy e.g. child with leukaemia | Meningioma will typically present with midline shift in the frontal lobe
56
What are the signs of a vestibular schwannoma?
Facial nerve palsy Corneal reflex absent Nystagmus Hydrocephalus
57
What should be performed in any child with a midline tumour?
AFP Beta-hcg LDH But not in increased ICP (risk of herniation)
58
What are symptoms of frontal lobe tumours/stroke/lesions?
Contralateral weakness due to deficit in primary motor cortex Personality changes including disinhibition and cognitive slowing Urinary incontinence due to disruption of micturition inhibition centre Gaze abnormalities if involvement of frontal eye fields Expressive dysphasia if brocas involved Seizures
59
What are the symptoms of a temporal lobe tumour/ stroke/ lesion?
Memory deficit Receptive aphasia if wernickes Contralateral superior quadrantanopia Seizures
60
What are the symptoms of a parietal lobe tumour/ stroke/ lesion?
Contralateral weakness and sensory loss Contralateral inferior quadrantanopia Dyscalculia - difficulty with maths Dysgraphia- difficulty in ability to write Finger agnosia - inability to distinguish fingers Left-right disorientation- confusion between right and left limbs If dominant lobe affected; gerstmann syndrome If non-dominant lobe affected; neglect, dressing apraxia and constructional apraxia
61
What are the symptoms of an occipital lobe tumour/ stroke/ lesion?
Contralateral homonymous hemianopia | Visual hallucinations
62
What are the symptoms of a cerebellar tumour/ stroke/ lesion?
``` Ipsilateral ataxia N+V Dizziness and vertigo Slurred speech Intention tremor ```

Neurology (48 decks)

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