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Neuro 4 > CNS Tumors and EEG > Flashcards

CNS Tumors and EEG Flashcards

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1
Q

EEG finding: Normal background w/ focal temporal sharp and slow waves

A

= temporal lobe epilepsy

-most common type of common partial epilepsy

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2
Q

EEG finding: 3 Hz spike-wave discharges

A

Typical Absence Seizures

-typical of childhood absence epilepsy

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3
Q

EEG finding: Slow spike-wave complexes

A

Atypical absence seizures

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4
Q

EEG finding: 4-6 Hz polyspike-wave discharges

A

Myoclonic Seizures = Epileptic Myoclonus

-seen in juvenile myoclonic epilepsy

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5
Q

EEG finding: Sudden diffuse/generalized attenuation or generalized polyspike wave

A

Tonic/Atonic seizures

Generalized polyspikes also a feature of generalized tonic-clonic seizures

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6
Q

Which type of seizures is known to have a strong genetic component

A

Febrile seizures

-runs in families => higher risk for the child if afebrile seizures in a family member

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7
Q

Most common brain tumor in adults

A

High grade gliomas = glioblastoma (grade IV astrocytoma) and anaplastic astrocytoma (grade III astrocytoma)

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8
Q

Most common brain tumor in children

A

Pilocytic astrocytomas

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9
Q

Most common malignant brain tumor in children

A

Medulloblastoma (2nd most common childhood brain tumor overall)

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10
Q

Which CNS tumor is associated w/ MEN (multiple endocrine neoplasia) type I

A

pituitary adenoma

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11
Q

Which CNS tumor is associated w/ NF type I

A

Neurofibroma

recall: NF = neurofibromatosis

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12
Q

Which CNS tumor is associated w/ NF type II

A

Schwannoma

recall: NF = neurofibromatosis

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13
Q

What are astrocytomas?

A

Tumors arising from astrocytes (cells that support neurons by supplying nutrients etc)

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14
Q

What CNS tumor is associated w/ BRAF mutation?

A 
Pilocytic astrocytoma (WHO Grade I)
-most common CNS tumor of childhood
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15
Q

Name the astrocytomas

(a) WHO Grade I
(b) WHO Grade II
(c) WHO Grade III
(d) WHO Grade IV

A

Astrocytomas

(a) Grade I = pilocytic astrocytoma
(b) Grade II = diffuse astrocytoma
(c) Grade III = anaplastic astrocytoma
(d) Grade IV = glioblastoma

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16
Q

What feature classifies as astrocytoma as grade III?

A

Presence of mitotic figures = anaplastic astrocytoma (Grade III)

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17
Q

Name the two different types of diffuse gliomas

A
  • astrocytomas (from astrocytes)

- oligodendrogliomas (from oligodendrocytes- myelinate CNS neurons)

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18
Q

What is the most common malignant brain tumor of adults?

A

Glioblastoma (grade IV astrocytoma)

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19
Q

What is pseudopalisading necrosis a molecular feature of?

A

Glioblastoma

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20
Q

What is the survival rate of glioblastomas?

A

50% 1 year survival

-

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21
Q

What is the most common malignant brain tumor of children

A

Medulloblastoma

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22
Q

What is the prognosis of medulloblastoma?

A

Good cure rate, but this requires such aggressive intervention (radiation and chemotherapy) that the quality of life is so low after curing

  • many of the ppl that are cured can’t live on their own
  • shows decrease in IQ as a consequence of therapy
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23
Q

What is the cell of origin of medulloblastomas?

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A

Primitive neuroblasts

24
Q

Why is it so hard to tell the prognosis of ependymal tumors

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A

Very poor correlation btwn histology and outcome

25
What is the most accurate way to tell prognosis of a CNS tumor
- molecular features | - now becoming better than histologic features
26
What is the cell of origin of ependymal tumors?
Cells lining the central canal or ventricles
27
What is the cell of origin for meningiomas?
Arachnoid cap cells- present in the outer layer of arachnoid matter
28
What percent of brain tumors are metastases?
15-25% -so almost a quarter! => anytime you diagnose a brain tumor, gotta
29
What are the most common places from which brain mets come from?
Lung, breast, melanoma, and kidney cancer
30
Which CNS tumor is associated w/ Li-Fraumeni syndrome
Choroid plexus tumors
31
Which choroid plexus tumor is more common in children?
Malignant (carcinoma) are more common in children, while papillomas (benign) are more common in adults
32
What are verocay bodies a molecular finding of?
Schwannoma
33
What is nuclear palisading?
= verocay bodies | -indicative of schwannoma
34
What is a schwannoma?
- benign nerve sheath tumor around peripheral nerve | - almost always benign
35
Clinical presentation of a brain tumor
Subacute = weeks to month - headache - change in mental status - focal neurologic deficit
36
What are some eloquent areas of the brain?
Eloquent meaning you can't resect a tumor here (or can't w/o some serious consequence) - language areas - primary motor cortex - basal ganglia - brainstem - spinal cord
37
What are psammoma bodies indicative of?
Histological findings indicative of papillary thyroid cancer or meningioma
38
Where can meningiomas arise?
Anywhere where arachnoid matter is present- so skull vault (space btwn skull and brain), ksull base, convexities of the brain, parasagittal -also at the optic nerve sheath or spinal cord
39
What grade are most meningiomas?
Most meningiomas are benign - 65-80% benign = WHO grade I - 20-35% atypical = WHO grade II - 1-3% malignant or anaplastic = WHO grade 3
40
Differentiate the WHO Grades of meningiomas (a) Grade I vs. grade II (b) Grade II vs. grade III
Meningiomas come in 3 grades depending on recurrence rate and mitotic activity (a) Grade I: Most are curable after total resection. Occur more in F > M. While Grade IIs recur at a rate of 30-45% at 5 years and are histopathologically more aggressive: mitotic index > 4, hypercellularity, brain invasion (b) Grade 2s have 30-45% 5-year recurrence rate and > 4 mitotses/10HPF. Grade 3s have a 72-78% recurrence rate at 5 years and are commonly invasive. Grade 3s have > 20 mitoses/10 HPF and exhibit frank anaplasia (undifferentiation of cell types)
41
What gender has a higher rate of Grade I meningiomas? Possible explanation?
F > M - possible assocation w/ hormones - some meningiomas express ER and PR - pts w/ breast cancer have a 1.5-2.0 increase risk of meningioma
42
What is the only environmental risk factor for gliomas and meningiomas?
High dose radiation ex: atomic bomb survivors
43
What is the most likely initial mutation in sporadic menigiomas?
NF2 mutations
44
What is the best route of treatment for grade I meningiomas?
-if just incidentally found on imaging (not growing and asymptomatic)- observation is reasonable, then take action if grows or becomes symptomatic - Radiation therapy and complete resection shown to have same effect for grade I (benign) - often cured after complete resection -chemo is NOT effective against meningiomas
45
What is the best route of treatment for grade II and III meningiomas?
Surgical resection and/or radiation therapy | -then recurrence increases w/ grade
46
How are gliomas categorized? (a) What are the two most common gliomas?
Gliomas are classified by their cell of origin- glial is the general umbrella terms for all the types of supporting cells in the CNS (a) Astrocytomas and glioblastomas (astrocytomas classes I and IV) make up 76% of all gliomas
47
What CNS tumor is pseudopalisading necrosis a feature of?
Glioblastomas (GBM)
48
What CNS tumor is associated w/ TERT mutation?
Glioblastoma
49
Describe the effect of a IDH 1/2 mutation on glioma outcome?
Mutation of IDH 1/2 is actually a favorable risk factor -mutated IDH 1/2 survive longer than wild type
50
What rare cancer syndrome is associated w/ a mutation in the PTEN gene?
Cowden
51
What rare cancer syndrome is associated w/ a mutation in the TP53 gene?
Li-Fraumeni
52
Describe two things used to diagnose a glioma (or really any other CNS tumor)
(1) Imaging- diagnoses initially made by CT/MRI (2) Tissue biopsy- at this point histology is how we categorize, but we're moving towards molecular features/markers to predict prognosis (much better)
53
What CNS tumor is associated w/ an increased risk for DVT?
GBM (glioblastoma) -30-60% of all GBM pts develop DVT during the course of disease
54
Treatment for gliomas
- maximal safe resection | - radiation: benefit but really doesnt elongate that much
55
What is it controversial to radiate anaplastic gliomas (WHO III)
Radiation is associated w/ permanent neurocognitive decline - attentional dysfunction - severe cognitive impairment

Neuro 4 (6 decks)

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