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Y3 NEUROLOGY > Intracranial Tumours > Flashcards

Intracranial Tumours Flashcards

1
Q

Primary intracranial neoplasms are the __ most common tumours in children. True/False?

A

2nd

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2
Q

List the typical clinical presentations/symptoms of intracranial neoplasms

A

Progressive neurological deficit
Motor weakness
Headache
Seizures

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3
Q

List clinical presentations/symptoms of raised intracranial pressure

A 
Headache
Vomiting
Mental changes
Seizures
Visual impairment
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4
Q

Neurological signs of tumours correlate with anatomical location and function. List the features associated with the frontal lobe and common pathologies

A 
Thought
Reasoning
Behaviour
Memory
Movement
Broca's aphasia (dominant hemisphere)
PERSERVATION (INCREASED SPASTICITY/ TONE)
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5
Q

Neurological signs of tumours correlate with anatomical location and function. List the features associated with the temporal lobe and common pathologies

A 
Behaviour
Memory
Hearing and vision
Emotion
Wernicke's aphasia (dominant hemisphere)
MEMORY AND AUDITORY HALLUCINATIONS
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6
Q

Neurological signs of tumours correlate with anatomical location and function. List the features associated with the parietal lobe and common pathologies

A 
Intellect
Thought
Reasoning
Memory
Sensation
INATTENTION/ NEGLECT (non-dominant)
GERSTMANN SYNDROME (disease of dominant angular gyrus: dysgraphia, left-right disoreintation, finger agnosia, acalculia)
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7
Q

Neurological signs of tumours correlate with anatomical location and function. List the features associated with the occipital lobe and common pathologies

A 
Speech
Motor and sensory
Abstract concepts
Visual
VISUAL FIELD DEFECTS, HAEMANOPIAS
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8
Q

List all potential investigations that may be done for suspected intracranial neoplasms

A 
CT
MRI +/- contrast
Lumbar puncture
PET scan
Lesion biopsy
EEG
Angiography
Radionucleotide study
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9
Q

Describe WHO grade I astrocytic tumours

A

Pilocytic

Pleomorphic xanthoastrocytoma

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10
Q

Describe WHO grade II astrocytic tumours

A

Low grade astrocytoma

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11
Q

Describe WHO grade III astrocytic tumours

A

Anaplastic astrocytoma

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12
Q

Describe WHO grade IV astrocytic tumours

A

Glioblastoma multiforme

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13
Q

Who is typically affected by grade I astrocytic tumours?

A

Children
Young adults
Typically headache with vomiting and low appetite

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14
Q

What is the treatment of choice for grade I astrocytic tumour?

A

Surgery (curative)

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15
Q

Grade II astrocytic tumours (low grade astrocytoma) have predilection for which brain lobes?

A

Temporal
Frontal
Parietal

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16
Q

List poor prognostic factors for low grade astrocytomas

A 
Age over 50
Focal deficit
Short duration of symptoms
Raised ICP
Altered consciousness
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17
Q

Outline treatment options for low grade astrocytomas

A

Radio/chemo -therapy

Surgery

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18
Q

Which carries poorer prognosis - anaplastic astrocytoma or glioblastoma multiforme?

A 
Glioblastoma multiforme (1 year)
Anaplastic astrocytoma (2 years)
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19
Q

List some chemotherapy agents that may be used for astrocytic tumours

A

Temozolamide (CA inhibitor)
Procarbazine
Carmustine wafers

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20
Q

Which lobe do oligodendroglial tumours predominately affect?

A

Frontal lobe

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21
Q

Describe the morphology of oligodendroglial tumours (buzzword)

A

Grayish-pink
Toothpaste-like
Visible calcification!

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22
Q

What is the median survival for oligodendroglial tumours?

A

10 years

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23
Q

What % of intracranial tumours are meningiomas?

A

20%

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24
Q

Majority of meningiomas are asymptomatic. True/False?

A

True

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25
Q

What is meningioma en plaque?

A

Subtype of meningiomas that infiltrate dura and sometimes bone
Carpet/sheet-like lesions

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26
Q

Meningiomas are usually malignant. True/False?

A 
False
Histologically benign (90%)
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27
Q

Outline treatment of meningioma

A

Pre-operative embolization
Surgery
Radiotherapy

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28
Q

What do pineal tumours typically obstruct?

A

CSF outflow, leading to hydrocephalus

29
Q

Raised intracranial pressure can lead to…

A

Haemorrhage or herniation

30
Q

What sign would suggest herniation in a patient with raised ICP?

A

Sudden increase in ICP

31
Q

What is enclosed within the cranial cavity? Give percentages

A

80% brain
10% blood
10% CSF

32
Q

List some features of headache associated with intracranial tumours

A

Occur in the morning

Typically with coughing/ leaning forward and vomiting

33
Q

List the aetiology of tumour headache

A

Increased tumour headache
Compression of dura/ BVs/ periosteum
Compression of CNs (III, IV, VI) at the brainstem —. diplopia
Extreme hypertension
Psychogenic (stress of loss of functional capacity)

34
Q

What is Cushing’s triad of ICP?

A

Hypertension
Bradycardia
Irregular respirations

35
Q

How do you treat suspected papilloedema in the acute setting?

A

Mannitol

36
Q

How do low grade astrocytomas typically present?

A

Seizures

37
Q

What sign on imaging would suggest low grade astrocytomas may have grown, and increased grade?

A

Contrast enhancement

38
Q

What is the most common primary intracranial tumour?

A

Glioblastoma multiforme

39
Q

Outline treatment options for anaplastic astrocytoma and glioblasta multiforme tumours

A

Noncurative surgery to increase survival
Supramarginal resection
Post-op radiotherapy
Tezolamide

40
Q

List some side effects of radiotherapy

A

Reduced IQ
Thin skin
Hair loss
Fatigue

41
Q

In what situations of intracranial tumours is driving restricted?

A

Seizure risk
Homonymous visual field defect
FOR 1 YEAR

42
Q

Who is typically affected by oligodendroglial tumours?

A

Adults (25-45 years)

Children

43
Q

How do oligodendroglial tumours typically present?

A

Seizure

Headaches

44
Q

Outline treatment options for oligodendroglial tumours

A

Surgery
CHEMOTHERAPY
(Radiotherapy can reduce seizures and increase life expectancy)

45
Q

How do meningiomas typically present?

A

Headaches
Cranial nerve neuropathies (skull base)
Regional anatomical disturbance

46
Q

What is the median survival for meningiomas?

A

5 years

47
Q

What is the most common acoustic neuroma?

A

Vestibular schwannoma

48
Q

How do acoustic neuromas typically present?

A

Loss of hearing
Tinnitus
Dysequilibrium
Hydrocephalus (morning headache)

49
Q

Outline treatment options for acoustic neuromas

A 
Audiometry
Radiographic evaluation
VP shunt (hydrocephalus)
Radiotherapy
Surgery
50
Q

What are some post-op complications of acoustic neuromas?

A

Facial nerve palsy
Corneal reflex
Nystagmus
Abnormal eye movement

51
Q

Who is typically affected by meningiomas?

A

Females

52
Q

Who is typically affected by pineal tumours?

A

Young males (<20 yo)

53
Q

Germinomas are sensitive to radiotherapy/ chemotherapy

A

Radiotherapy

54
Q

List the types of non-germinomatous tumours, and which tumour markers are useful for each

A

Teratoma (AFP)
Yolk sac tumour (AFP, pALP)
Choriocarcioma (bHCG)
Embryonal carcinoma

55
Q

Which tumour markers are present in germinomas?

A

bHCG

pALP

56
Q

Bilateral haemanopia and endocrine abnormality would make you think of which type of tumour? What investigations would you request?

A

Pituitary tumour

Full endocrine profile - prolactin, GH, IGF1, TSH, FT4, FT3, cortisol, FSH/LH
MRI
Visual fields and acuity

57
Q

A raised prolactin or prolactinaemia can be managed with what drug?

A

Cabergoline

58
Q

Which harmones are raised in acromegaly? How is it diagnosed and managed?

A

GH, IGF1

Measure GH levels after glucose
Surgery
Somatostatin analogues

59
Q

List some signs of cushing’s disease?

A 
Lemon sticks
Stria
Fatigue
Proximal mypopathy
Buffalo hump
60
Q

What is the main complication of acromegaly to be aware of?

A

Heart failure

61
Q

What are the main signs of panhypopituitarism? Which harmone declines first?

A

Pallor, yellow skin, fine wrinkling
Absent axillary hair
Puffy face
Expressionless

GH

62
Q

GBM tumours are typically found in..

A

Elderly people

63
Q

What is the characteristic sign on MRI for GBM tumours?

A

Butterfly appearance

64
Q

Haemangioblastomas typically present with what signs?

A

Signs of raised ICP and cerebellar dysfunction

65
Q

Haemangioblastomas are associated with what long term condition?

A

Von-Hippel Linkdau syndrome

66
Q

What is the characteristic sign on MRI for haemangioblastomas?

A

Black flow voids in tumour (blood vessels)

67
Q

What are the main clinical tests used in cushings disease?

A

Low dose dexa for excess cortisol

High dose dexa to distinguish between adrenal and pituitary causes

68
Q

What anatomical sites are cerebral metastases most likely to be derived from?

A

Breast
Lung
Skin
Colon

69
Q

Which intracranial tumour is the most common tumour in children?

A

Medullablastoma

Y3 NEUROLOGY (22 decks)

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