Brain Tumours

Question 1

How do brain tumours commonly present?

Answer 1

• Progressive neurological deficit
• Motor weakness
• Headache
• Seizures

Question 2

What are the signs of increased intracranial pressure?

Answer 2

Headaches, vomiting, mental changes, seizures

Question 3

State the key red flag for brain tumours

Answer 3

Headache that wakes you up at night, is worse lying down and in the morning, worse with coughing and not relieved by pain killers

Question 4

Name three types of herniation

Answer 4

Subfalcine
Uncal
Tonsillar

Question 5

What is Cushings Triad and what is it a sign of?

Answer 5

Hypertension, bradycardia, irregular respiration

- a sign of impending herniation

Question 6

What percentage of patients with a brain tumour have papilloedema?

Answer 6

<10%

Question 7

How can you tell the location of a brain tumour?

Answer 7

The signs correlate to location in the brain

Question 8

What does DANISH stand for?

Answer 8

Disdiadochokinesis
Ataxia
Nystagmus 
Intention tremor
Slurred speech 
Hypotonia

Question 9

State the investigations carried out on a suspected brain tumour

Answer 9

CT/MRI (CT easy to access but MRI gold standard)
Lumbar puncture 
PET scan 
Lesion biopsy 
EEG 
Evoked potentials 
Angiograms 
Radio-nucleotide studies

Question 10

Name the two main subtypes of glioma

Answer 10

Astrocytoma

Oligodendroglioma

Question 11

How are astrocytomas classified?

Answer 11

Grade 1-4

Question 12

Describe grade 1-4 astrocytomas

Answer 12

1 - Mixed glial and neuronal
2 - Low grade
3 - Anaplastic
4 - Glioblastoma

Question 13

Describe grade 1 astrocytoma

Answer 13

Truly benign, slow growing in children/young adults homogeneous and can be cured with surgery

Question 14

How do astrocytomas present in kids?

Answer 14

Ataxia
Tiptoe walking
Vomiting
Headache

Question 15

What is a rare variant of grade 1 astrocytoma?

Answer 15

Pilocytic - involvement of optic nerve, hypothalamic glioma or cerebellum

Question 16

Name three common sites for a grade 2 astrocytoma

Answer 16

Temporal lobe
Posterior frontal lobe
Anterior parietal

Question 17

Describe grade 2 astrocytoma

Answer 17

Pleomorphic with vascular proliferation and necrosis, presents with seizures

Question 18

State the factors for poor prognosis for a grade 2 astrocytoma

Answer 18

>50years old 
Focal deficit 
Short duration 
Raised ICP 
Enhancement 
Altered consciousness 
Progression to malignant

Question 19

What is the treatment for grade 2 astrocytoma?

Answer 19

Surgery and PCV chemo and radiotherapy

Question 20

What can happen if the astrocytoma is not treated effectively?

Answer 20

It can become a glioblastoma

Question 21

Name the two malignant astrocytoma

Answer 21

• anaplastic

- glioblastoma

Question 22

What is the expected survival for anaplastic astrocytoma?

Answer 22

2 years

Question 23

Describe a glioblastoma

Answer 23

Most common, can occur as a primary tumour, <1 year survival spreads via white matter/CSF

Question 24

How can malignant astrocytomas be managed?

Answer 24

Surgery - cytoreduction, reduce symptoms
Radiotherapy
TMZ chemo
All in combination give 14 month survival

Question 25

What is the danger with TMZ chemotherapy?

Answer 25

CSF leaks can occur due to placement of chemotherapy

Question 26

What is the age restriction for radiotherapy?

Answer 26

3 years old as it drops your IQ by 10

Question 27

How do oligodendrogliomas often present and why?

Answer 27

Seizures due to slow growing tumour in frontal lobe

Question 28

In an oligodendroglioma what is the classic appearance of subarachnoid accumulations?

Answer 28

Toothpaste morphology

Question 29

What is a collision tumour?

Answer 29

Mix of astrocytic and oligodendroglial cells

Question 30

What do oligodendrogliomas look like?

Answer 30

Calcified with cysts and peritumoral haemorrhage

Question 31

Are oligodendrogliomas usually benign or malignant?

Answer 31

Usually low grade but can have malignant conversion

Question 32

What is the treatment for oligodendrogliomas?

Answer 32

Surgery, PCV chemo, radiotherapy

Question 33

What is the survival for oligodendroglioma?

Answer 33

10 years

Question 34

Describe meningioma en plaque

Answer 34

Carpet like lesion infiltrates the dura and sometimes invades bone

Question 35

Where do meningiomas originate?

Answer 35

Arachnoid granulations they are extra-axial

Question 36

Name four common sites of meningioma

Answer 36

- parasagittal - convexity - sphenoid - intraventricular

Question 37

What are the symptoms of meningiomas?

Answer 37

Headaches, cranial nerve neuropathies, regional disturbance

Question 38

What percentage of meningiomas are benign?

Answer 38

90%

Question 39

What type of cancer can metastasise to the meninges?

Answer 39

Breast

Question 40

Name four aggressors

Answer 40

- clear cell - chordoid - rhabdoid - papillary

Question 41

Where will radiation induced tumours arise?

Answer 41

Midline (childhood leukaemia)

Question 42

How do meningiomas look on CT?

Answer 42

Homogeneous, dense enhancement, oedema and hyperostosis

Question 43

How do meningiomas look on MRI?

Answer 43

Dural tail, patency of sinuses

Question 44

What can help with resection of meningiomas?

Answer 44

Embolisation of tumour vasculature

Question 45

Define tumour blush

Answer 45

Increasing hypervascular arterial phase and slow venous washout

Question 46

How are meningiomas treated?

Answer 46

Surgery, radiotherapy but it may just be left

Question 47

How can an acoustic neuroma present?

Answer 47

Hearing loss, tinnitus, dysequilibrium, 5th,7th,8th cranial nerve dysfunction, brainstem, hydrocephalus

Question 48

State the buzzword for the appearance of an acoustic neuroma on imaging

Answer 48

Ice cream cone

Question 49

How are acoustic neuromas managed?

Answer 49

Medically more than surgically - radiosurgery is gold standard

Question 50

Post radiosurgery what are the complications?

Answer 50

Facial nerve Palsy Corneal reflex Nystagmus Abnormal ocular movements

Question 51

State the peak incidence for pineal tumours

Answer 51

10-12 years old

Question 52

Where can pineal tumours metastasise to?

Answer 52

CSF

Question 53

How are geminomas treated?

Answer 53

Radiosensitive if >3 years old

Question 54

Name four non-germinatous tumours

Answer 54

Yolk sac Teratoma Choriocarcinoma Embryonal carcinoma

Question 55

What tumour markers can be used in pineal tumours?

Answer 55

Alpha feto-protein Beta HCG LDH

Question 56

If tumour markers are negative what investigation is required?

Answer 56

Biopsy

Question 57

What techniques can be used to treat hydrocephalus?

Answer 57

Endoscopic Third Ventriculostomy | VP Shunt

Question 58

Name three key signs of pituitary tumour

Answer 58

- endocrine abnormality - headache - bitemporal hemianopia

Question 59

What investigations are done in suspected pituitary tumour?

Answer 59

``` Prolactin (cabergoline can treat) GH/IFG 1 - acromegaly can cause HCOM Cortisol - cushings TSH, FSH, LH Visual fields/acuity ```

Question 60

After removal of a pituitary tumour what condition can arise?

Answer 60

Panhypopituitarism