CNS Tumours Clinical

Question 1

What is the aetiolgoy of brain tumours?

Answer 1

Primary unknown
Genetic
Metastatic causes

Question 2

What are the most common primary sites of brain metastases?

Answer 2

Lung 
Kidney 
Breast 
GI 
Melanoma

Question 3

How are CNS tumours classified?

Answer 3

Based on tissue of origin
Location
Primary or secondary
Grading

Question 4

How are tumours graded?

Answer 4

GX Grade cannot be assessed (Undetermined)
G1 Well-differentiated (Low grade)
G2 Moderately differentiated (Intermediate grade)
G3 Poorly differentiated (High grade)
G4 Undifferentiated (High grade)

Question 5

How do CNS tumours present?

Answer 5

Depends on location, size and type of tumour

Question 6

What are the general signs and symptoms of CNS tumours?

Answer 6

Increased ICP 
Causing:
Headaches worse in morning 
Nausea 
Vomiting 
Papilleedema 
Cognitive impairment 
Altered consciousness 
Focal neurologic deficits
Seizures

Question 7

What are the signs and symptoms of cerebral tumours?

Answer 7

Headache 
Vomiting 
Hemiparesis 
Hemiplegia 
Hypokinesia
Seizures 
Changes in personality or behaviour

Question 8

What are the signs and symptoms of brainstem tumours?

Answer 8

o	Hearing loss (acoustic neuroma)
o	Facial pain and weakness
o	Dysphagia, decreased gag reflex
o	Nystagmus
o	Hoarseness
o	Ataxia

Question 9

What is the sign in cerebellar tumours?

Answer 9

Disturbances in co-ordination and equilibrium

Question 10

What are the signs and symptoms of a pituitary tumour?

Answer 10

Endocrine dysfunction
Visual deficits (pressure on the optic chiasma)
Headache

Question 11

What are the signs and symptoms of a frontal lobe tumour?

Answer 11

Inappropriate behavior
Personality changes
Inability to concentrate
Impaired judgment
Memory loss
Headache
Expressive aphasia
Motor dysfunctions

Question 12

What are the signs and symptoms of a parietal lobe tumour?

Answer 12

Sensory deficits
Paresthesia
Loss of 2 pt discrimination

Question 13

What is the sign of a occipital lobe tumour?

Answer 13

Visual disturbances

Question 14

What are the classifications of intra-axial tumours?

Answer 14

• Gliomas
  1. Astrocytoma (Grades
  I,II)
  2. Anaplastic
  Astrocytoma(III)
  3. Glioblastoma
  Multiforme(IV)
• Oligodendroglioma
• Ependymomas
• Medulloblastoma
• CNS Lymphoma

Question 15

What are the classifications of an extra-axial tumour?

Answer 15

Meningioma 
Metastatic 
Acoustic neuromas 
Pituitary adenoma 
Neurofibroma

Question 16

What are the characteristics of meningiomas?

Answer 16

Slow growing
Attached to meninges
Usually benign

Question 17

What is the 2nd most common primary brain tumour?

Answer 17

Meningioma

Question 18

Where do meningiomas arise from?

Answer 18

Arachnoid cap cells from arachnoid membrane

Question 19

Are meningiomas invasive?

Answer 19

Not usually

Question 20

Do meningiomas affect more F or M?

Answer 20

F

Question 21

What are the symptoms of meningioma?

Answer 21

Generally slow growing so asymptomatic for ages 
Headaches 
Blurred vision 
Numbness 
Speech problems 
Seizures

Question 22

What imaging is done for meningioma?

Answer 22

CT

MRI

Question 23

What other investigation can be done for meningioma?

Answer 23

Biopsy

Question 24

What is the scale for astrocytomas?

Answer 24

• Low grade astrocytomas
• Diffuse low grade astrocytomas
• Glioblastomas

Question 25

What is the presentation of diffuse low grade astrocytoma?

Answer 25

Seizures Headache Slowly progressive neurological deficits

Question 26

Which is the most common primary type of brain tumour in adults?

Answer 26

High grade glioblastoma

Question 27

Where are high grade glioblastomas usually located?

Answer 27

Cerebral hemispheres

Question 28

Where are diffuse grade astrocytomas usually located?

Answer 28

Frontal region

Question 29

How do high grade glioblastomas present?

Answer 29

Seizures Headache Slowly progressive neurological deficits

Question 30

Where do oligodendrogliomas arise from?

Answer 30

Myelin

Question 31

Where are oligodendrogliomas located?

Answer 31

Superficially in frontal lobes

Question 32

What is the presentation of oligodendrogliomas?

Answer 32

Seizures Headache Slowly progressive neurological deficits

Question 33

What are investigations for oligodendrogliomas?

Answer 33

CT | MRI

Question 34

Are brain mets single or multiple?

Answer 34

Can be either

Question 35

What investigations should be used to diagnose CNS tumours?

Answer 35

CT MRI PET scan

Question 36

Which investigation is most widely used for the diagnosis for brain tumours?

Answer 36

CT

Question 37

What is CT more useful for than MRI?

Answer 37

Detecting acute haemorrhage, calcification and bony involvement

Question 38

What are the benefits of MRI scanning for brain tumours?

Answer 38

More sensitive than CT scan Can detect small tumours Provides much greater anatomical detail Good for visualising tumours of the skull base, brain stem and posterior fossa tumours

Question 39

What is the surgical treatment for CNS tumours?

Answer 39

Resection | Biopsy

Question 40

When might you use a transsphenoidal route?

Answer 40

Approach through nasal pasage to remove pituitary tumour

Question 41

What does radiation therapy?

Answer 41

Damages DNA of rapidly dividing cells

Question 42

What does chemotherapy do?

Answer 42

Slows cell growth

Question 43

What is the purpose of performing a biopsy?

Answer 43

To remove a piece of the tissue to determine the type of tumour

Question 44

What are the risk factors for CNS tumours?

Answer 44

Often unknown FH Ionizing radiation Environmental hazards

Question 45

What investigation is contraindicated in CNS tumours?

Answer 45

LP

Question 46

What is the treatment for glioblastoma?

Answer 46

``` Complete excision impossible Biopsy or debulk Radiotherapy Corticosteroids Anticonvulsants ```

Question 47

What is the most common pituitary tumour?

Answer 47

Pituitary adenoma

Question 48

What would bitemporal hemianopia suggest?

Answer 48

Pituitary tumour

Question 49

What are red flags for CNS tumours?

Answer 49

``` Weight loss Anorexia Focal neurological deficit Change in headache Worse in morning headache Signs of increased ICP Vomiting Seizures ```

Question 50

What is the treatment for pituitary adenoma?

Answer 50

Endocrine replacement Transsphenoidal surgery Drug therapy Radiotherapy