Lecture 65: Brain tumors

Question 1

Brain tumors w/ headache (%); w/ JUST headache (%)

Answer 1

30%; 1%

Question 2

T/F: Primary brain tumors are usually metastatic

Answer 2

False

Question 3

Worst brain tumor; what grade/cell type? Survival? Histology?

Answer 3

Glioblastoma multiforme; grade IV astrocytoma; median = 1 year; pseudopalisading

Question 4

Most common primary brain tumor?

Answer 4

Glioma

Question 5

Describe glial resection

Answer 5

Difficult; but if low grade complete resection is better than debulking alone

Question 6

What is a butterfly glioma? Operable?

Answer 6

Glioma that crosses CC; no

Question 7

Glialoma treatment options

Answer 7

1. Whole brain radiation; 2. Resection (if low grade)

Question 8

Risk of radiation therapy?

Answer 8

Radionecrosis of brain tissue

Question 9

Oligodendendroglioma patient population and presentation

Answer 9

Middle age, F>M, frontal lobe, fried egg appearance; 5 year survival

Question 10

Ependymoma patient population and thing to remember

Answer 10

Children/young adults, posterior fossa/spinal cord, rosettes, can cause hydrocephalus; OFTEN SEED

Question 11

Choroid plexus tumors are common/rare and cause, patient population. Most common ventricle? Presentation?

Answer 11

Rare; over secretion of CSF (hydrocephalus), children; fourth ventricle; increased ICP (VI nerve palsy = diplopia)

Question 12

Meningiomas are most common in women/men; young/old; benign/malignant; histology?

Answer 12

Women, older (>40), benign; psamommma bodies

Question 13

What can induce a meningioma?

Answer 13

Radiation therapy

Question 14

Treatment (2); probably won’t use…

Answer 14

Nothing if they’re small or surgical removal (not always easy); radiation/chemotherapy

Question 15

Olfactory groove meningioma can lead to…presents as?

Answer 15

Dementia; anosmia

Question 16

Other places for meningiomas

Answer 16

F

Question 17

Common schwannoma, prsentation, treatment

Answer 17

Acoustic neuroma; tinnitus/deafness/compression of other CNs (VII); surgery

Question 18

Common pituitary tumors (2)

Answer 18

Pituitary adenomas, craniopharyngiomas

Question 19

Pituitary tumor types (2)

Answer 19

Micro and macroadenomas (are large and can compress structures)

Question 20

Pituitary tumors can do what…two most common?

Answer 20

Secretion of hormones; prolactinoma, then GH

Question 21

If your growth plates have NOT closed and you get a GH secreting pituitary tumor, you get…

Answer 21

Giantism

Question 22

Craniopharyngiomas often contain, patient population, and associated problems

Answer 22

Calcium; young children; hypothalamic and visual problems, hydrocephalus (3rd ventricle problems)

Question 23

Pinealomas hint

Answer 23

Elevated HCG or alpha fetoprotein

Question 24

% Brain tumors due to metastasis

Answer 24

50%

Question 25

Medulloblastoma patient population and region it affects? Presents as? Are these malignant?

Answer 25

Second most common pediatric BT after glioma; cerebellum; acute obstructive hydrocephalus; YES, they seed

Question 26

Hemangioblastoma are often where and can secerete what?

Answer 26

Cerebellum; erthropoietin

Question 27

Describe primary cerebral lymphoma: patient population and outcome

Answer 27

Immunosuppressed; cognitive impairment due to RT, poor outcome

Question 28

How often do people with systemic cancer get brain metastasis? (%)

Answer 28

20-30%

Question 29

Subfalcine herniation (def) and presentation

Answer 29

Herniation under falx: headache, contralateral leg weakness (not very serious)

Question 30

Uncal herniation puts pressure on _________, producing ____________ (ipsi or contralateral? What’s the final symptom (ipsi or contralateral)? Will a patient be awake? Why?

Answer 30

Midbrain; contralateral hemiparesis; ipsilateral IIIrd nerve palsy; no, loss of consciousness due to distortion of ARAS in midbrain

Question 31

What is a strange consequence of an uncal herniation? This is what kind of sign?

Answer 31

Kernohan notch: herniation pushes against OPPOSITE edge of tentorium ipsilateral paresis; “false localization” sign

Question 32

Central herniation causes what kind of deterioration…

Answer 32

Rostro-caudal deterioration (one brainstem syndrome after another)

Question 33

Cerebellar tonsils can herniate into…bad when?

Answer 33

Foramen magnum; Coma and death result when these herniations compress the brain stem.

Question 34

So…four herniation syndromes?

Answer 34

Subfalcine, central, uncal, cerebellar tonsillar

Question 35

How do we treat herniation?

Answer 35

First: remove lesion then treat cerebral edema

Question 36

Types of cerebral edema

Answer 36

Vasogenic, cytotoxic, interstitial, osmotic

Question 37

Vasogenic edema; treatment?

Answer 37

Breakdown of BBB; steroids

Question 38

Cytotoxic edema

Answer 38

BBB intact, problem in cellular functioning

Question 39

Wilderness medicine! Important cytotoxic edema point

Answer 39

Altitude can cause cytotoxic edema

Question 40

Interstitial edema seen in? Treatment:

Answer 40

Seen in obstructive HC; SHUNT

Question 41

Osmotic edema; associated with…

Answer 41

Impairment of osmolality of blood; water intoxication and dialysis