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Neurology > Brain Tumours > Flashcards

Brain Tumours Flashcards

(48 cards)

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1
Q

What is the most common extra-axial tumour

A

Meningioma

Benign tumour

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2
Q

Give examples of extra-axial tumours

A 
Meningioma 
Pituitary adenoma 
Acoustic neuroma or vestibular schwannoma 
Choroid plexus papilloma 
Craniopharyngioma
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3
Q

How do brain tumours cause raised ICP

A

Additional mass within the closed box of the skull
Can cause mass effect, blockage of CSF flow or haemorrhage
All will raise the pressure

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4
Q

How does raised ICP present

A

Headache,
Vomiting,
Low GCS and seizures

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5
Q

How does uncal herniation present

A

Unilateral blown pupil (dilated)

Due to compression of 3rd nerve

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6
Q

What are the signs of a tumour headache

A

Worse in the morning
The pain wakes them up
Worse on coughing and leaning forward
May be associated with vomiting

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7
Q

When would a tumour cause a headache

A

If it is pressing on the dura or periosteum
The brain itself doesn’t have pain receptors but these structures do
Can be due to raised ICP
Secondary to visual disturbances

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8
Q

What visual disturbances can tumours cause

A

Diplopia - due to compression of CNIII, IV, VI
Difficulty focusing
Blown pupil - CNIII

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9
Q

Functional symptoms of a brain tumour are related to the location - true or false

A

TRUE

Will affect the function controlled by that lobe of the brain

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10
Q

What is the sign of papilloedema

A

Loss of the optic disc on fundoscopy

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11
Q

What is the most common brain tumour

A

Metastasis from another tumour

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12
Q

What are the most common investigations for brain tumours

A 
CT 
MRI 
PET scan 
Lumbar puncture 
Angiogram 
Biopsy 
EEG
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13
Q

What are the 4 grades of astrocytic tumours

A 
I = pilocytic astrocytoma 
II = low grade astrocytoma 
III = anaplastic astrocytoma 
IV = glioblastoma multiforme
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14
Q

From which cells do glial tumours arise

A

astrocytes or oligodendrocytes

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15
Q

Describe pilocytic astrocytoma

A

Benign - slow growing
More common in children
Surgery is curative

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16
Q

Where do low grade astrocytoma most commonly affect

A

Temporal lobe

Frontal lobe - posterior and anterior sections

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17
Q

How do low grade astrocytoma’s present

A

Seizures

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18
Q

What are the poor prognostic factors for a low grade astrocytoma

A 
Age over 50
Focal deficit (seizures)  
Raised ICP
Short duration of symptoms
Altered consciousness 
Enhanced contrast studies
Incomplete resection
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19
Q

How do you treat low grade astrocytoma’s

A

Resect tumour within reason (may need to leave small areas if near a crucial structure)
If the tumour is incompletely resected then we give radiotherapy and chemotherapy
The tumour will most likely come back but they can have a good quality of life in the

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20
Q

Describe anaplastic astrocytomas

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A

Malignant tumour
Median survival of <2 years
Can operate to reduce symptoms but wont cure - surgery and radiation

21
Q

Describe glioblastoma multiforme

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A

malignant
most common primary tumour
survival is around 14 months regardless of treatment
Treatment to improve QoL not cure - surgery and radiation

22
Q

How can tumours be visualised for surgery

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A

5AMA
Patient drinks the substance and it taken up in the brain
Shows up tumour cells as pink if blue light is shone on it

23
Q

Which chemotherapy is commonly used for brain tumours

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A

Temozolomide – oral chemotherapy
PCV
Can deliver chemo onto brain itself with carmustine wafers but it does impede wound healing

24
Q

How is radiotherapy used in the treatment of brain tumours

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A

Used after surgery on malignant tumours
Used if there has been incomplete resection
Used for recurrence of benign tumours

25
Describe oligondendriglial tumours
Arise from oligodendrocytes Affect the frontal lobes Occur in adults 25-40 Present with seizures
26
What are collision tumours
Oligodendroglial cells coexist with astrocytic cells in a neoplastic collision type of tumour Both cell types in tumour
27
How do you treat oligodendroglial tumours
Tend to be chemosentive | Treat with chemo and surgery
28
How might brain tumours present in children
Tiptoeing, ataxia and vomiting
29
How do meningiomas present
Most are asymptomatic | May cause headache or cranial nerve neuropathies
30
Meningiomas can be induced by radiation - true or false
True | common after treatment for childhood leukaemia
31
What is tumour blush
Sign seen on angiogram | Diffuse spread of contrast on image in the area of the tumour
32
How do you treat meningiomas
Preoperative embolization Surgery Radiotherapy
33
How do temporal lobe tumours present
With seizures
34
How do frontal lobe tumours present
Personality changes
35
How do acoustic neuromas present
Hearing loss Tinnitus Balance problems
36
What are acoustic neuromas
also called vestibular schwannomas | Tumours of the 8th cranial nerve
37
How do you treat acoustic neuromas
Hearing aids and monitoring when small Surgery Radiation Hydrocephalus management
38
What tumour markers must be tested in a child with a midline tumour
AFP, HCG and LDH | Need to check if its a germ tumour
39
How can you surgically treat hydrocephalus
VP shunt - ventriculoperitoneal | Fluid transferred to peritoneum where it can be reabsorbed
40
How do brain tumours generally present
``` Focal symptoms - dependant on location Headache Vomiting Seizures Visual disturbance Papilloedema ```
41
Where do most childhood brain tumours occur
below the tentorium cerebelli
42
What types of cancer most commonly metastasise to the brain
``` Breast Bronchus Kidney Thyroid Colon Metastatic melanomas ```
43
Where in the brain are mets often found
Boundaries between grey and white matter
44
Benign brain tumours usually don't cause much of a problem - true or false
FALSE | Can still cause significant symptoms due to compression of brain
45
High grade malignant brain tumours often don't metastasise - true or false
TRUE
46
Describe medulloblastoma
2nd most common tumour in kids Poorly differentiated Occurs in the midline Radiosensitive - good survival with resection and radiotherapy
47
If you suspect a headache is caused by a brain tumour, what is the first test you can do in clinic to confirm
Fundoscopy - look for papilloedma
48
If someone is found to have multiple brain mets, what should you do
Urgent CT chest, abdo, pelvis to look for the primary

Neurology (18 decks)

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