Lec 63 CNS Tumors

Question 1

What causes localizing symptoms of brain tumors?

Answer 1

those caused by tumor invasion or compression of particular structures

ex: aphasia, weakness, visual field cut, seizure, etc

Question 2

What causes non-localizing symptoms of brian tumors?

Answer 2

elevation in ICP due to mass itself, cerebral edema, or hydrocephalus secondary to obstruction

ex: N/V, headache, mental status change

Question 3

What is most common location of tumors in adults vs children?

Answer 3

adults = supratentorial
kids = infratentorial

Question 4

What is mainstay of tumor therapy?

Answer 4

surgical resection

Question 5

What are glial tumors [gliomas]? 3 types?

Answer 5

tumor of glial cells

• astrocytomas [malignant or not]
• ependymoma
• oligodendroglioma

Question 6

What is most common type of primary brain tumor [glial or non-glial]?

Answer 6

glial = 80%

Question 7

Where are gliomas usually located?

Answer 7

• frontal lobe
• insula
• parieto-occipital region
• splenium of corpus callosum
• thalamus

Question 8

What is glioblastoma multiforme [GBM]?

Answer 8

• grade 4 astrocutyoma
• common, highly malignant primary brain tumor
• 1 year median survival
• found in cerebral hemisphere; can cross corpus callosum = butterfly glioma

Question 9

What are the 4 grades of glioma called?

Answer 9

grade 1/2 = low grade
1 = fibrillary astrocytoma
2 = astrocytoma or oligodendroglioma
3 = anaplastic astrocytoma / oligodendroglioma
4 = GBM

Question 10

What is treatment for glioma?

Answer 10

supportive care, surgery, try chemo/radiation

prognosis = < 1 year

Question 11

What are risks for glioma?

Answer 11

age, male, ionizing radiation

3 pks of incidence: children, 30-40 yrs, > 65 yrs

Question 12

What are symptoms of glioma?

Answer 12

increased ICP, seizures

Question 13

What is life expectancy for low grade astrocytoma?

Answer 13

5 yrs

Question 14

What is hemangioblastoma? where is it usually?

Answer 14

usually cerebellar

fried egg appearance

Question 15

What is ependymoma? where is it usually?

Answer 15

usually in spaces of posterior fossa but also can be in spinal cord or region of cauda equina

most frequentyl in children/young adults

Question 16

What are signs of infratentorial ependymoma?

Answer 16

N/V, headahce, other signs related to hydrocephalus, CN signs and symptoms

Question 17

What is pathology of oligodendroglioma?

Answer 17

fired egg; chicken wire capillary pattern

often calcified

Question 18

Where are ependymomas commonly found?

Answer 18

in 4th ventricle

Question 19

What is prognosis of ependymoma?

Answer 19

poor prognosis, associated wtih hydrocephalus

Question 20

What are characteristic pathologies of ependymoma?

Answer 20

characteristic perivascular rosettes, rod shaped blepharoplasts [basal ciliary bodies] near nucleus

Question 21

Are ependymomas more frequently seen in children or adults?

Answer 21

children

Question 22

What are characteristics of glial choroid plexus tumors?

Answer 22

• only tumors causing hydrocephalus by over-secretion of CSF rather than blockage
• classified as papillomas [benign] or carcinomas [malignant]
  more common in childhood
  most foten occur in 4th ventricle

Question 23

What are signs of choroid plexus glial tumors?

Answer 23

high ICP [N/V, headache, lethargy], hydrocephalus [excess CSF], deficit eye movement due to pressure on roots of 3, 4, or 6

Question 24

What are characteristics of meningiomas?

Answer 24

• second most common brain tumor
• arise from meninges
• typically benign primary tumor
• often asymptomatic
• may present with seizure or focal neurological signs, loss of small [if in olfactory groove]

Question 25

What are risk factors for meningioma?

Answer 25

female, radiation, neurofibromatosis

Question 26

What is pathology of meningioma?

Answer 26

dural tail = attachment to dura extra axial = external to brain parenchyma psammoma bodies and whorls of cells

Question 27

What is treatment for meningioma??

Answer 27

resect if symptoms present, may need radiosurgery

Question 28

What type of tumor should you think: pseudopalisading

Answer 28

glioblastoma

Question 29

Where do meningiomas most often occur?

Answer 29

convexities of hemispheres near surface of brain and parasagittal region

Question 30

What age group gets meningioma?

Answer 30

age 50-70 but grows slowly

Question 31

What are characteristics of pituitary adenoma? what is most common type?

Answer 31

most common = prolactinoma present with: bitemporal heminaopia due to pressure on optic chiasm, hyper or hypo pituitarism

Question 32

Who commonly gets craniopharyngioma?

Answer 32

young children

Question 33

What is a cranipharyngioma?

Answer 33

benign childhood tumor may be confused with pituitary adenoma b/c both can cause bitemporal hemianopia derived from remnants of rathke pouch, calcification common

Question 34

What are characteristics of medulloblastoma?

Answer 34

highly malignant common childhood tumor usually cerebellar tumor = get vermal symptoms and obstructive hydrocephalus form of primitive neuroectodoermal tumor can compress 4th ventricle

Question 35

what are symptoms of pituitary tumors?

Answer 35

hyperprolactinemia [lactating, gynecomastia] or acromegaly [gigantism in children]

Question 36

What is pathology of medulloblastoma?

Answer 36

homer-wright rosettes sold [gross] small blue cells

Question 37

What is non-glial hemangioblastoma?

Answer 37

syndromic and hereditary = von hippel lindau [mut in tumor suppressor gene VHL] can secrete erythropoietin usually originates cerebellum treated with embolization then surgery

Question 38

what are characteristics of primary cerebral lymphoma?

Answer 38

associated with HIV, immunosuppression, EBV primary B cell lymphoma steroid sensitive + treated with chemo/radiation often have cognitive impairment and poor outcome

Question 39

Where do brain metastases usually come from?

Answer 39

lung > breast > melanoma, GI, renal | spread via blood

Question 40

Are metastases infra or supratentorial?

Answer 40

supratentorial

Question 41

How does subfalcine herniation present?

Answer 41

headache and as progresses --> contralateral leg weakness

Question 42

How does transtentorial [central] herniation present?

Answer 42

pupils and respirations change depending on how far down brain it herniates can lead to stupor, coma - pupil irregular then fixed at midposition - oculocephalic movements difficult - extensor posturing spontaneously - motor tone increased

Question 43

What are signs of uncal herniation?

Answer 43

contralateral hemiparesis CN III palsy [dilated pupil] duret hemorrhages can lead do decrease level of consciousness

Question 44

What should you think if you have dilated pupil in absence of decreased consciousness?

Answer 44

NOT uncal herniation

Question 45

What is kernohan's notch?

Answer 45

sign of severe uncal herniation causes false localizing sign = large mass effect pushes midbrain against opposite side of tentorium --> paradoxical hemiparesis ipsilateral to lesion instead of contralateral CN3 still on ipsilateral leg: use pupil dilation > hemiparesis to localize the lesion

Question 46

What are signs of tonsillar herniation?

Answer 46

cerebellar tonsils move down through foramen magnum --> compression of medulla oblongata and upper cervical spinal cord may cause cardiac and respiratory dysfunction

Question 47

What is vasogenic edema? cause?

Answer 47

breakdown of tight endothelial junctions [BBB] | due to: trauma, tumors, focal inflammation

Question 48

What is cytotoxic edema? cause?

Answer 48

BBB intact --> problem in cellular function [NA/K pump] | seen in reyes syndrome, hypothermia, altitude, psuedomotor

Question 49

What is interstitial edema?

Answer 49

seen in obstructive hydrocephalus | due to impairement in BB with transependymal flow of CSF

Question 50

What is osmotic edema?

Answer 50

impaired osmolality of blood