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Neuromuscular management > Lecture 11: Tumors and Infections > Flashcards

Lecture 11: Tumors and Infections Flashcards

1
Q

What is a neoplasm

A

benign or malignant expanding lesion whose constituent cells multiply without restraint and form a mass

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2
Q

What is a primary tumor?

A

arise from CNS cells

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3
Q

What is a secondary tumor?

A

metastatic from other primary sites

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4
Q

Most CNS tumors are __________

A

metastases from other locations n body

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5
Q

What is the most common type of cancer in children?

A

brain/CNS cancer

note: second most common cause of death in children

second most common cause of death in males 20-39

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6
Q

Men have a higher incidence of ____________

women have a higher incidence of ______________

A

men: brain tumors

women: meningeal tumors

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7
Q

What kind of tumor is most common in children?

adults?

A

Children: pilocytic astrocytoma

adults: meningioma and glioblastoma

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8
Q

Where are tumors most commonly found in children?

adults?

A

Children: 70% in posterior fossa

adults: 70% in cerebral hemisphere

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9
Q

What are the two different symptom classifications that tumors cause

A

focal (as a result of the tumor location)

generalized (as a result of overall increased intracranial pressure)

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10
Q

Symptoms of increased intracranial pressure?

A

headache
-worse in am
-worse bending over
-seen in 50% of pts with brain tumor

nausea

papilledema

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11
Q

What does this depict?

A

Hydrocephalus

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12
Q

What does the monroe-kellie doctrine state?

A

There’s only limited volume in the skull, balance of CSF, Blood, and Brain is constant

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13
Q

a subfalcine (cingulate) herniation can compress the __________ artery that runs along the falx, can cause infarction and further swelling

A

ACA

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14
Q

A cingulate herniation presses the ___________ under the falx to the contralateral side

A

cerebral hemisphere

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14
Q

What symptoms does pressure on the tentorial notch from an uncal herniation cause

A

Ipsilateral dilated pupil (CN III)

impaired conciousness

hemiparesis

PCA infarcts

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14
Q

uncal herniation affects what parts of the brain?

A

hippocampus, uncus of temporal lobe, tentorial notch

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15
Q

What kind of herniation pushes the brain through the foramen magnum?

A

Tonsillar herniation : pushes the cerebellar tonsils through the foramen magnum

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16
Q

What is compressed due to a tonsillar hernation?

A

4th ventrical and medulla

symptoms: stiff neck progressing to decerebrate posturing and coma

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17
Q

What kind of imaging is best for CNS tumors?

A

MRI

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18
Q

What is a tumor in the spinal cord called?

A

intramedullary

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19
Q

What is a tumor lying on the surface of the cord that arises from roots or meninges called?

A

extramedullary-intradural

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20
Q

what is a tumor in the epidural space that is able to compress the spinal cord called?

A

extradural

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21
Q

What kind of spinal cord tumor is most commonly from metastases?

A

extradural

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22
Q

How are CNS tumors named?

A

based on their hisological appearance to CNS cell types

example:

gliomas- glial cells

mengiomas - arachnoid cels

neuroblastoma, neurocytoma- neurons

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23
What is the most common **tumor** location?
Meninges/meningioma
24
What kind of brain tumor has the worst prognosis?
glioblastoma -very high rate of mitosis, vascular proliferation, necrosis
25
Grade 1 glioma?
Pilocytic Astrocytoma
26
grade 2 glioma?
low grade astrocytoma
27
grade 3 glioma?
anaplastic astrocytoma
28
grade 4 glioma?
glioblastoma
29
What is the most common location of astrocytoma?
Cerebral hemisphere mostly supra-tentorial
30
Astrocytoma prognosis?
median survival 9-17 years 80% survive 5+ years continous monitoring from malignant transformation treatment: surgery, radiation, chemo
31
What factors would indicate a favorable prognosis for astrocytoma?
Younger age seizure as only symptom (not headache) smaller tumor size
32
Glioblastoma has a higher incidence in ___________ median survival? presenting symptoms?
men 1.5 years focal signs, cognitive changes, increasing ICP
33
What kind of brain tumor is located in the cerebellum, primary affects children at the age of 6, and drops metastases into the CNS/spinal cord
Medullablastoma
34
What kind of brain tumor can block the 4th ventrical and cause hydrocephalus?
medulloblastoma
35
What is the most common primary brain tumor?
Meningioma
36
What kind of tumor is benign, slow growing, incidence increases w/ age, and affects more females than males
meningioma
37
What is the most common form of brain cancer in adults?
metastasis from other cancers -primarily from lungs (50%) -breasts (15%)
38
What does this MRI show?
Metastases to CNS (usually multiple masses at gray/white junction)
39
T or F, metastases is usually found in routine workup
T
40
What drug treats raised intracranial pressure? What drug treats seizures?
Dexamethasone, Mannitol Levetiracatem or Lacosamide
41
Most spinal cord metastases occur where?
70% Thoracic
42
What are the symptoms of spinal cord metastases?
Back pain, tenderness, paraparesis, incontinence
43
Ambulatory vs nonambulatory prognosis for spinal metastatic disease?
If ambulatory, 90% of patients remain ambulatory if nonambulatory under 10% of patients survive 1 year
44
Where is leptomeningeal metastases? Prognosis?
Either at the **basal cistern or cauda equina**, 5% of all metastatic cancers usually **very poor** prognosis
45
What is paraneoplastic disease
group of disorders that are associated with cancer but not directly caused by cancer
46
Polyneuropathy Polymyositis or dematomyositis cerebellar degen limbic or brainstem encephalitis necrotizing myelopathy lambert eaton **These are all what?**
Paraneoplastic disorders
47
Chemotherapy complications
Neuropathy delirium dementia seizures headache vision loss cerebellar dysfunction
48
radiation complications
headache worsening of neurological symptoms radiation necrosis cognitive impairment neuropathy myelopathy vasculopathy endocrinopathy
49
meningitis, brain abscess, subdural empyema, dural sinus thrombophlebitis, and focal bacterial encephalitis these are are examples of...
bacterial infections of the CNS
50
What are the symptoms of meningitis?
Fever Chills Headache neckpain/stiffness generalized convulsions drowsiness/confusion
51
What is one major symptom of meningitis in infants
Buldging of fontanels (soft spots) note: also vomiting/irritability
52
What is brudzinski's neck sign? Kernig's sign?
signs of meningitis brudzinski- flexing patient's neck caused flexion of hips and knees kernigs sign- flexing patients hip to 90 then extending patients knee causes pain
53
Meningitis causes thrombosis in _______ more than ________
veins more than arteries
54
How does meningitis cause hydrocephalus?
Bacteria in CSF causes inflammatory reaction -> exudate of neutrophils and proteins -> exudate blocks uptake of CSF causing hydrocephalus
55
CSF in meningitis will show ____ WBC ____ Protein ____ glucose
increased increased decreased note: cloudy appearance
56
What common pathogens can give newborns meningitis?
E Coli
57
T or F, acute menngitis is a medical emergency
T
58
T or F, Bacterial meningitis often requires a higher dose of antibiotics to penetrate the blood brain barrier
T
59
What kind of meningitis tends to occur in roughly 10 year cycles has a rapid onset over hours and leads to hemorrhagic skin rash
Meningococcal meningitis
60
What is the difference between viral meningitis and bacterial meningitis?
Viral Meningitis * CSF has **lymphocytic** **predominance** (not WBCs) * **Normal** glucose levels Bacterial Meningitis * Increase WBC * Increase protien * Decrease glucose
61
What are the 2 most common viral causes of meningitis?
enterovirus, herpes simplex virus
62
What is acyclovir medicine
Used to treat herpes simplex virus
63
What kind of meningitis should be assumed for treatment purposes before tests are ran?
Bacterial
64
What is the hallmark of acute encephalitis
Impaired conciousness note: also fever, impaired conciousness, seizures, hemiparesis, ataxia, cranial nerve palsies
65
Herpes simplex encephalitis is usually caused by what kind of HSV?
HSV1
66
What is the worst kind of viral encephalitis what lobes does it affect
herpes simplex mortality rate of 50% usually dominates in **temporal and frontal** lobes
67
How does herpes simplex encephalitis present and evolve?
rapid evolution of fever, confusion, coma
68
Whats the difference in progression between HSV1 meningitis and tuberculosis meningitis
HSV1 progresses rapidly tuberculosis progresses over weeks
69
how does tuberculosis reach the brain?
from bloodstream after pulmonary infection note: hydrocephalus and stroke are frequent w/ tuberculosis meningitis
70
What symptoms are frequent w/ tuberculous meningitis
cranial nerve palsies
71
What does the CSF look like (**lab values**) during tuberculosis meningitis?
increased pressure increased lymphocytes increased protein and decreased glucose
72
What condition is this? Purulent infection of the subdural space
Subdural empyema
73
where does subdural empyema usually come from?
Arises from sinus or middle ear
74
How is subdural empyema usually treated
**surgical drainage** and then **antibiotic** afterwards
75
What is intracranial thrombophlebitis
thrombosis in **venous sinus** caused by infection blockage leads to increase ICP and focal neurological finding
76
What is a brain abscess?
occurs when there is **necrosis of brain tissue** along with **bacterial** infection
77
Where will a brain abscess usually appear that is secondary to ear or sinus infection
near the site of entry
78
what are the symptoms of brain abscess?
headache drowsiness confusion seizures focal findings
79
80
What are the 3 stages of neurosyphilis
1. early meningitis - 6-12 months after infection 2. meningovascular syphilis - 5-12 years after primary infecton 3. late tertiary syphilis - tabes dorsalis and general paresis
81
Where does lyme disease come from?
Transmitted by bite of infected blacklegged tick (not in texas) borrelia burgdorferi bacteria
82
What are the symptoms of lyme disease initially: weeks- months:
initially: fever, **rash**, fatigue, headache weeks- months: CN palsies, meningitis, radiculopathy, neuropathy, cardiac disease
83
What 2 fungi can infect the CNS?
**Cryptococcosis** - most common in US, seen in AIDS patients **Mucormyocosis** - seen as complication of diabetes
84
What kind of pattern does a rash from herpes zoster/shingles cause?
appears as a dermatomal pattern of just one dermatome
85
**Where** does herpes zoster/shingles infection come from? **Who** does it affect? **What** does it cause?
reactivation of latent chicken pox virus usually affects elderly causes radicular pain
86
What is the most common neurological symptoms of covid?
Anosmia (75%) note: other CNS complications seen in 30% of patients
87
What are the most common symptoms of long covid?
Dyspnea, Fatigue
88
What is prion disease? Symptoms? Prognosis?
Sporadic creutzfeldt-jakob disease (caused by prion proteins) causes rapidly progressive **dementia**, behavior changes, **ataxia**, **myoclonic jerks, blindness** fatal within 1 year
89
Most mass lesions of the brain in AIDS are ____________
toxoplasmosis or primary CNS lymphoma
90
With HIV and AIDS, opportunitistic infection is seen when the __________ count drops
CD4
91
T or F, AIDS and HIV can affect the nervous system at any level
T
92
What is neurocytiscerosis?
worms in the brain worms in the brain worms in the brain worms in the brain worms in the brain worms in the brain worms in the brain worms in the brain worms in the brain worms in the brain worms in the brain worms in the brain worms in the brain worms in the brain worms in the brain
93
What are the symptoms of neurocysticerosis?
seizure, headache, **arachnoiditis** (inflammatory reaction to cysts in arachnoid space)
94
How do you treat neurocysticerosis?
**Antiparasitics** (still need surgery after to remove the dead worms bc they still cause seizures) steroids surgery

Neuromuscular management (19 decks)

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