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Neuro > CNS Tumors - Exam 3 > Flashcards

CNS Tumors - Exam 3 Flashcards

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1
Q

_____ is responsible for personality characteristics, decision making,
voluntary muscle movement, speech production, short term memory

A

frontal lobe

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2
Q

_____ lobe is responsible for the sense of touch and interpretation of objects and space

A

Parietal

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3
Q

_____ lobe is responsible for short and long-term memory, understanding of speech,
hearing and emotions

A

temporal lobe

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4
Q

____ lobe is responsible for visual sense and interpretation

A

occipital lobe

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5
Q

____ lobe is responsible for coordination, balance and equilibrium

A

cerebellum

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6
Q

Cranial nerves _____ through ____ all arise from the brainstem

A

3-12 all arise from the brainstem

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7
Q

Symptoms of a CNS tumor will reflect one of 3 pathological processes. What are they? How do the symptoms present?

A

Functional area of the brain involved

Compression of adjacent structures

Increased intracranial pressure

insidious in onset and can be general or focal

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8
Q

Generalized symptoms of a CNS tumor often present like _______

A

increased intracranial pressure

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9
Q

_____ is the most common manifestation of brain tumors and is often the worst symptom– occurs in 50% of patients. Describe them

A

HA

HA’s are often nonspecific and resemble tension-type headaches (40-80%) or migraines

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10
Q

What are the characteristics of a HA that is consistent with a CNS tumor?

A

dull, constant ache, occasional throbbing

bifrontal with increased pain on the same side of the tumor

progresses over time

pain increases with change in body position or any raises in ICP

pain at night or pain that wakes you up from sleep

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11
Q

**What are the red flag symptoms associated with HA?

A
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12
Q

What is the N/V associated with CNS tumors due to? What can trigger them that would make you think it is due to CNS tumor?

A

due to increased ICP

Emesis triggered by abrupt change in body position

Neurogenic emesis – emesis present with other neurological symptoms such as headache or neuro deficits

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13
Q

HA
N/V
Altered Level of Consciousness/Syncope
seizure
neurocognitive dysfunction

What am I?

A

CNS tumor

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14
Q

In CNS tumors, what is the Altered Level of Consciousness/Syncope due to? What is it triggered by?

A

Significant rise in ICP can lead to a loss of cerebral perfusion resulting in diminished and loss of consciousness

Triggered by position change or activities that further increase ICP

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15
Q

Syncope due to increased ICP may results in ______

A

seizure activity

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16
Q

_____ are one of the most common symptoms in primary and metastatic tumors. What do these depend on?

A

Focal seizures

intensity, type and frequency depends on the location of the tumor

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17
Q

What lobe? _____ focal tonic-clonic movements involving one extremity, inability to perform cognitive tasks

A

Frontal lobe

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18
Q

What lobe? _____ visual disturbances

A

occipital lobe

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19
Q

What lobe? ______ abrupt behavioral/memory changes with or without aura

A

temporal lobe

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20
Q

What lobe? _____ sensory seizures
auditory and/or tactile hallucinations or numbness in a part of the body

A

parietal lobe

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21
Q

What are focal symptoms clinical presentation based on?

A

functional location of tumor or compression of surrounding structures

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22
Q

What lobe?
Personality changes
Progressive intellectual decline
Difficulty with concentration and memory
Expressive aphasia
anosmia
contralateral weakness

A

frontal lobe

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23
Q

What is expressive aphasia? What region of the brain?

A

Word finding hesitation or word substitutions

able to think clearly but not able to expressive themselves verbally

Broca’s region

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24
Q

What is anosmia? What part of the ____ lobe?

A

the partial or total loss of the ability to smell due to pressure on the olfactory nerve

base of the frontal lobe

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25
Sensory seizures: tactile hallucinations Contralateral disturbances of sensation: loss of sensation that is NOT consistent with dermatomes astereognosis Visuospatial deficit, R/L awareness What lobe?
Parietal Lobe Lesions
26
Homonymous hemianopia Loss of color perception Sensory seizure- visual hallucinations Prosopagnosia Visual Simultagnosia What lobe? What is Prosopagnosia? What is Simultagnosia?
occipital lobe Prosopagnosia: Inability to recognize a familiar face Simultagnosia: Inability to integrate and interpret a composite scene as opposed to its individual elements
27
Olfactory (smell) or gustatory (taste) hallucinations Auditory illusions or hallucination Motor phenomena such as licking or smacking of the lips Depersonalization, emotional or behavioral changes Sensations of déjà vu long-term memory impairment Lack of language comprehension (Wernicke's) What lobe? What is the difference between illusions or hallucinations?
temporal illusion have stimulus and hallucinations do NOT have a stimulus
28
Cranial nerve palsies (III - XII) Ataxic gait Nystagmus Altered reflexes Where is the lesion?
brainstem
29
Marked ataxia of the trunk Incoordination and hypotonia of the limbs Where is the lesion?
cerebellar lesion
30
What is the classic triad of ICP?
headache, nausea/vomiting, and papilledema
31
What are 3 pathophysiologic processes that result in ICP?
Large mass Restriction of CSF outflow causing hydrocephalus Disruption of the blood brain barrier by angiogenesis of the tumor leading to edema
32
What are 3 types of herniation due to ICP?
subfalcial transtentorial/uncal cerebellar-foramen magnum/tonsillar
33
a subfalcial herniation may occlude the _______ leading to _____ lobe infarction
anterior cerebral artery frontal position 1
34
a transtentorial/uncal herniation compresses _______, midbrain and ________. What does it lead to?
compression of CN III posterior cerebral artery Leads to ipsilateral pupillary dilation, followed by stupor, coma, decerebrate posturing, and respiratory arrest aka a unilateral blown pupil is NOT GOOD position 2
35
Cerebellar–foramen magnum/tonsillar compression of the ______ causing apnea, circulatory collapse, and death
medulla position 3
36
What is the imaging of choice for a CNS tumor? Why is it better?
MRI Brain with contrast (gadolinium) Detects the lesion and defines its location, shape, and size. Can detect normal anatomy distortion. demonstrates the degree of any associated cerebral edema or mass effect
37
What are the CI for a brain MRI? What is the next best option?
metallic implants, embedded devices, or uncontrolled claustrophobia CT scan with iodine
38
A brain CT with contrast is not helpful in detecting _______ or _____ lesions
unable to detect small lesions or those in the posterior fossa
39
When is a MR spectroscopy indicated? How does it work?
indicated in tumors that do not enhance on MRI with contrast Measures biochemical changes (chemical metabolism) in the brain and compares it to the chemical composition of the normal brain tissue. Tissue activity is plotted on a graph with varying heights
40
What is the management for a pt with a CNS tumor? How do you determine urgent vs outpt?
refer to neurosx!! urgent: large, symptomatic tumors - signs of increased ICP or impending herniation outpt: smaller tumors and those with minimal symptoms
41
What do you do pharm management wise for a CNS tumor?
Dexamethasone-> to reduce seizures if the pt has had a seizure: start AED medications (levetiracetam (Keppra), topiramate (Topamax), lamotrigine (Lamictal), valproic acid, and lacosamide (Vimpat))
42
What antiseizure drugs do you want to avoid in a pt with a CNS tumor?
AVOID phenytoin and fosfphenytoin
43
**What is MORE IMPORTANT for a pt with a CNS tumor that is showing s/s of an impending herniation or midline shift?
**secure an airway!!! super important that this gets done ASAP
44
What are the generic tx options for CNS tumors?
Surgical excision Radiation - main treatment if needed after resection Chemotherapy Symptomatic therapy: Corticosteroids, Anticonvulsants Palliative care
45
What are glial cells? What are the 4 types of CNS glial cells?
Glial cells are supportive cells located around the axon but do not transmit electrical impulses Astrocyte Oligodendrocytes Ependymal cells Microglia
46
What type of glial cell? _______ have numerous projections that link neurons to their blood supply while forming the blood-brain barrier
astrocyte link neurons to their blood supply
47
What type of glial cell? _______ create myelin which forms the myelin sheath around the axon
Oligodendrocytes create myelin
48
What type of glial cell? _______ line the spinal cord and the ventricular system of the brain. They secrete CSF and beat their cilia to help circulate the CSF and make up the blood-CSF barrier
Ependymal cells secrete CSF and beat their cilia to help circulate the CSF
49
What type of glial cell? _______ clear cellular debris and dead neurons from nervous tissue through phagocytosis
microglia clear cellular debris and dead neurons
50
What are the 2 types of PNS glial cells?
Schwann cells Satellite cells
51
What type of PNS cell? ________ provide myelination to the axons of the PNS have phagocytic activity, clearing cellular debris allowing regrowth of PNS neurons
Schwann cells provides myelination and have phagocytic activity
52
What type of PNS cell? ________ surround (and protect) neuron cell bodies in sensory, sympathetic, and parasympathetic ganglia. Highly sensitive to injury and inflammation. Regulate the external chemical environment Provide nutrients to the neuron
satellite cells
53
What are the 4 responsibilities for a satellite cell?
surround (and protect) neuron cell bodies in sensory, sympathetic, and parasympathetic ganglia Highly sensitive to injury and inflammation and contribute towards chronic pain syndromes Regulate the external chemical environment Provide nutrients to the neuron
54
_____ cells are highly sensitive to injury and inflammation and contribute towards _______
satellite cells chronic pain syndromes
55
What are the 2 classifications of CNS tumors?
primary: arises from nothing aka originated in the brain metastatic tumor: MC- come from a cancer somewhere else in the body
56
What is the MC type of metastatic tumor that travels to the brain? give 4 more
lung- MC breast, melanoma, renal and colorectal
57
What is the only known risk factor for CNS tumor? ______ and _____ are at the highest risk
Exposure to ionizing radiation is the only known risk factor Therapeutic radiation and atomic bomb survivors are at highest risk
58
with regards to diagnostic radiation, ____________ is a risk factor for a CNS tumor. When will they typically present?
Diagnostic radiation: head CT exposure in children usually as early as 5 years after exposure
59
_______ increases your risk for CNS lymphoma
immunosuppression
60
What is the grading of CNS tumors based on? What is the scale?
cell differentiation and aggressiveness (mitotic figures, necrosis, vascular proliferation) Grade I-IV: 1 is least aggressive and IV is most aggressive
61
What are the 3 different kinds of MALIGNANT CNS tumors? Which one is MC?
Gliomas- MC Medulloblastoma Primary CNS lymphoma
62
What are the 3 different types of gliomas? Are these malignant or benign? Where can they occur?
astrocytomas oligodendrogliomas (ODs) ependymomas all are malignant brain or spinal cord
63
What is the only benign type of CNS tumor?
Meningioma
64
**WHO grade III will have the word _______ in the name
"anaplastic"
65
**WHO grade IV will either start with ______ or end with ________
"Glio" or "-blastoma"
66
What is the most aggressive type of astrocytoma?
Glioblastoma
67
______ is the MC type of glioma that is common in young children
Ependymomas
68
What is the management for glioma WHO grade I and II? **What are the 2 criteria/risk factors for observation as the next step?
complete surgical resection NEED BOTH in order to qualify for observation: less than 40 and clean margins on bx
69
If 1 of the risk factors are present with regards to WHO I and II management after bx, what is the next step? then what is next?
radiation followed by chemotherapy monitor for relapse: if occurs: sx, chemo and radiation
70
What is the management for WHO III and IV?
Maximal, safe resection with concurrent chemoradiotherapy consider clinical trials!!!!
71
______ is the MC malignant brain tumor in children. What is another name for it? Where does it originate?
Medulloblastoma cerebellar primitive and neuroectodermal tumor (PNET) cerebellum (posterior fossa)
72
What is the management for a Medulloblastoma? What is the survival rate?
Surgical resection Chemotherapy Radiation therapy 75% of pts survive into adulthood
73
_______ is MC associated with immunodeficiency states. If one is not obviously present, what do you need to do?
Primary CNS Lymphoma need to go find the source!! aka need to test for some immunodeficiency states
74
in primary CNS lymphoma, need to order CSF analysis to rule out Ddx of _______ in immunocompromised patients
toxoplasmosis
75
What is the management for primary CNS lymphoma?
glucocorticoids chemo radiation
76
in primary CNS lymphoma, want to avoid giving ______ if possible because it will interfere with the histology results. When should you give it?
glucocorticoids but need to give if you suspect herniation, midline shift or edema!!!!
77
______ is the 2nd MC primary CNS tumor. What is it?
Meningioma A tumor that develops on the dura mater or arachnoid mater
78
What is the WHO grading system for Meningiomas? What is causing the s/s?
I is benign II is “atypical” III is malignant Symptoms occur due to compression of surrounding neural structures and size
79
What is considered small in a meningioma? What is the tx?
Small (<2 CM) asymptomatic tumors may be conservatively managed with observation and repeat MRI in 3-6 months. If growth consider surgery vs irradiation
80
What is the management for Grade II and III meningiomas?
Grade II and III tumors require wide resection of tumor margins
81
What cancers are the MC to spread to the brain? Which one has the highest propensity to spread to the brain?
lung** MC, breast, melanoma, renal, colorectal melanoma has the highest propensity
82
What is the management for a metastatic CNS tumor? **Is bx necessary? Do s/s tend to progress more rapidly or slowly?
glucocorticoids, radiotherapy, chemotherapy and palliative surgery **Biopsy is usually not necessary progress more rapidly than primary tumors
83
What are the 3 kinds of spinal cord tumors?
intramedullary intradural-extramedullary extradural
84
What is the MC type of cancer found in the intramedullary spinal cord?
gliomas specifically -> ependymomas are the MC spinal glioma
85
What type of CNS tumors are found in the Intradural-extramedullary location of the spinal cord?
meningiomas nerve sheath tumors: Schwannoma, neurofibroma
86
What kinds of metastatic cancers tend to spread into the extradural location of the spinal cord?
prostate, breast and lung
87
What are some pathophys reasons behind the s/s seen with spinal cord tumros?
Direct compression of neurologic structures Ischemia secondary to arterial or venous obstruction Invasive infiltration
88
Localized pain - wakes nocturnally - gnawing and unremitting Sensory dysesthesias and muscular weakness may start unilaterally but progresses to bilateral involvement Bladder, bowel and sexual dysfunction may occur Progressive difficulty in ambulation What am I? What is the imaging of choice? What is the management?
spinal cord tumor tx: MRI spine with contrast management: glucocorticoids surgical decompression/removal radiotherapy
89
What is the SPIKES model for delivering bad news? just read the slide a couple times and you should be fine
90

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