Brain Tumours (Clinical) Flashcards by Robbie Pollock

What are common primary brain tumours?

neuroepitheal tissue - glioma (glioblastoma multiforme)

meninges - meningioma

pituitary - adenoma

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What are common secondary brain tumours?

Commonest tumours that spread to the brain are:

renal cell carcinoma
lung carcinoma
breast carcinoma
malignant melanoma
GI tract

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How many lesions is there in primary and secondary brain tumours?

in primary there is usually 1 but in secondary there can be many

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What is the most common brain tumour seen clinically?

Metastases

^{US >100 000 new cases year (17 000 primary tumours)}

^{15-30% patients with cancer will get cerebral metastasis}

^{15% cerebral metastasis is presenting symptom}

^{9% cerebral met is only detectible site of spread}

^{increasing incidence of cerebral metastases}

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What are gliomas?

Gliomas are derived from astrocytes - structural and nutritional support to nerve cells

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WHO grade gliomas I-IV, what is the most common grade and what are the features of it?

Grade IV:

most common
most aggressive
Glioblastoma multiforme (GBM)
spread by tracking through white mater and CSF pathway
very rarely spread systemically

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Are gliomas malignant?

yes but do not metastasise

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What is a meningioma?

A meningioma is a tumor that forms on membranes that cover the brain and spinal cord just inside the skull

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What are the characteristics of a meningioma?

slow growing

extra-axial

usually benign

arise from arachnoid

frequently occur along falx, convexity, or sphenoid bone

usually cured if completely removed

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WHat is the most common pituitary tumour?

adenoma most common

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Are pituitary tumours malignant?

no only 1% are

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What is the presentation of pituitary tumours?

visual disturbance due to compression of optic chiasm, bitemporal vision defect

hormone imbalance

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WHat is the clinical presentation of brain tumours?

raised intracranial pressure (mass effect)

focal neurological deficit

epileptic fits

CSF obstruction

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What are the symptoms of having raised ICP?

headache (typically morning headache)

nausea/vomiting

visual disturbance (diplopia, blurred vision)

somnolence

cognitive impairment

altered consciousness

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What are the signs of raised ICP?

papilloedema
6th nerve palsy - long cause so can be effected in many areas
cognitive impairment
altered consciousness
3rd nerve palsy

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How does a brain tumour cause hydrocephalus?

CSF production is 400 - 450 cc/day and we only have around 150 so produce 3 times the volume and therefore we circulate the CSF 3 times a day

Caused by tumours in or close to csf pathways (especially posterior fossa tumours)

especially in children

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How do you diagnose a brain tumour?

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history and examination

think of sources of secondary tumours (eg CXR)

CT scan

MRI scan

biopsy

What are some examples of focal neurologicl deificts?

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hemiparesis - weakness of one entire side of the body
dysphasia - language disorder marked by deficiency in the generation of speech, and sometimes also in its comprehension, due to brain disease or damage
hemianopia - blindness over half the field of vision
cognitive impairment (memory, sense of direction)
cranial nerve palsy
endocrine disorders

A 66 year old, left handed, woman presents with ataxia and in-coordination. Where would you suspect her lesion to be?

Left frontal lobe
Right frontal lobe
Brain stem
Cerebellum

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A 44 year old, right handed, woman presents with acalculia, agraphia, finger agnosia and right/left confusion. Where would you suspect her lesion to be?

Left parietal lobe
Right parietal lobe
Left occipital lobe
Cerebellum

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A 30 year old, right handed, man presents with a bi temporal hemianopia. Where would you suspect his lesion to be?

Right frontal lobe
Pituitary
Left optic nerve
Right occipital lobe

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50 year old 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}

6 week history of posterior rib pain

PMHx included a left nephrectomy for renal cell carcinoma 5 years previously

Left temporo-parietal area
Right fronto-temporal area
Left occipital lobe
Right parietal lobe

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dominant hemisphere is the left as right handed

Transferred to neurosurgery ward

Underwent a craniotomy and excision lesion

Histology confirmed this to be clear cell carcinoma consistent with renal primary

WHat ar ethe 2 kinds of epilepsy?

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focal or generalised

Epilepsy only occurs in lesions above the _________

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tentorium

WHat can epilepsy indicta ein relation to a tumour?

first fit - 20% chance of tumour draws attention to possibility of tumour indicates location of tumour

What happens if someone has multiple mestastses?

no surgery

Cana . tumour be removed by surgery?

yes

What investigations can be done for brian tumours?

Adequate cerebral imaging: CT, MRI, PET, (Angiography) If suspecting metastasis: - CT chest/abdo/pelvis - mammography - biopsy skin lesions/lymph nodes

What are the management goals?

accurate tissue diagnosis improve quality of life - decreasing mass effect/improve neurological deficit aid effect of adjuvant therapy (if required) prolong life expectancy

What are the different management principles?

corticosteroids (Dexamethasone) treat epilepsy (anticonvulsant drugs) analgesics/antiemetics counselling surgery radiotherapy chemotherapy endocrine replacement

What are the management options for glioblastoma multiforme?

complete surgical excision impossible - biopsy or debulk only medical: Steroids, anticonvulsants radiotherapy chemotherapy

What are the management options for metastasis (most important to confirm diagnosis)?

•11% with abnormal cerebral imaging and a history of cancer, do not have cerebral mets medical - steroids, anticonvulsants radiotherapy - whole brain, steriotatic -techniques for surgical treatment or scientific investigation that permit the accurate positioning of probes inside the brain or other parts of the body surgery

What is the prognosis of a meningioma?

commonly cured by surgery may require anticonvulsants (drug used for treatment of epileptic seizures)

What is the prognosis of astrocytomas?

low grade - long life expectancy high grade/GBM - average 1-1.5/2 yr survival

What is the prognosis of mestastases?

frequently good medium term remission

46 year old women Head injury 2004 when fell off bike Unable to work since as suffered post concussion syndrome Cerebral MRI performed as part of thorough neurological assessment Where is the lesion? 1. Brainstem 2. Occipital lobe 3. Cerebellum 4. Parietal lobe

What is the lesion likely to be? 1. Glioblastoma multiforme 2. Meningioma 3. Pituitary adenoma 4. Metastasis

What advice would you give? 1. Radiotherapy 2. Chemotherapy 3. Surgical excision 4. Nothing and get back to mountain biking

3 - cant always operate on all meningiomas though MRI demonstrated a lesion most likely to be meningioma Not thought that this was causing her symptomatology Patient wanted lesion removed

50 year old women 4th October presented to ED with decreased level of consciousness 1/12 of “slowing down” making uncharacteristic mistakes at work 4 day history of drowsiness headache and nauseated PMH - Nil No allergies, no medications Smokes pkt cigarettes/day, minimal alcohol Worked as a dog catcher Estranged from husband and lived with 19 year old daughter Examination findings: GSC 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 would you do next? 1. Lumbar puncture (LP) 2. CT/MRI brain 3. CXR 4. Full blood count

2 multiple lesions seen on CT

T1 (contrast) axial MRI

Definitely do NOT perform a lumbar puncture when there are signs and symptoms to suggest an intracranial mass lesion Why not do a LP? 1. You might cause meningitis 2. You might cause a herniation syndrome and the patient could die 3. You might cause an air embolism 4. You might make the patient’s headache worse

2 coning

**REVISION SLIDE** **Common types of brain tumours are**: metastasis (secondary) - renal, lung, malignant melanoma, breast, GI tract primary malignant - glioma (GBM) primary benign - meningioma and pituitary adenoma

**Brain tumours present with**: signs of raised intracranial pressure (headache, nausea/vomiting/papilloedema) seizures neurological deficit **Management:** appropriate investigations, ease symptoms, aid effect of adjuvant radiotherapy/chemotherapy, prolong life expectancy

Brain Tumours (Clinical) Flashcards

(42 cards)