Flashcards in Lecture 65: Brain tumors Deck (41):
Brain tumors w/ headache (%); w/ JUST headache (%)
T/F: Primary brain tumors are usually metastatic
Worst brain tumor; what grade/cell type? Survival? Histology?
Glioblastoma multiforme; grade IV astrocytoma; median = 1 year; pseudopalisading
Most common primary brain tumor?
Describe glial resection
Difficult; but if low grade complete resection is better than debulking alone
What is a butterfly glioma? Operable?
Glioma that crosses CC; no
Glialoma treatment options
1. Whole brain radiation; 2. Resection (if low grade)
Risk of radiation therapy?
Radionecrosis of brain tissue
Oligodendendroglioma patient population and presentation
Middle age, F>M, frontal lobe, fried egg appearance; 5 year survival
Ependymoma patient population and thing to remember
Children/young adults, posterior fossa/spinal cord, rosettes, can cause hydrocephalus; OFTEN SEED
Choroid plexus tumors are common/rare and cause, patient population. Most common ventricle? Presentation?
Rare; over secretion of CSF (hydrocephalus), children; fourth ventricle; increased ICP (VI nerve palsy = diplopia)
Meningiomas are most common in women/men; young/old; benign/malignant; histology?
Women, older (>40), benign; psamommma bodies
What can induce a meningioma?
Treatment (2); probably won't use...
Nothing if they're small or surgical removal (not always easy); radiation/chemotherapy
Olfactory groove meningioma can lead to...presents as?
Other places for meningiomas
Common schwannoma, prsentation, treatment
Acoustic neuroma; tinnitus/deafness/compression of other CNs (VII); surgery
Common pituitary tumors (2)
Pituitary adenomas, craniopharyngiomas
Pituitary tumor types (2)
Micro and macroadenomas (are large and can compress structures)
Pituitary tumors can do what...two most common?
Secretion of hormones; prolactinoma, then GH
If your growth plates have NOT closed and you get a GH secreting pituitary tumor, you get...
Craniopharyngiomas often contain, patient population, and associated problems
Calcium; young children; hypothalamic and visual problems, hydrocephalus (3rd ventricle problems)
Elevated HCG or alpha fetoprotein
% Brain tumors due to metastasis
Medulloblastoma patient population and region it affects? Presents as? Are these malignant?
Second most common pediatric BT after glioma; cerebellum; acute obstructive hydrocephalus; YES, they seed
Hemangioblastoma are often where and can secerete what?
Describe primary cerebral lymphoma: patient population and outcome
Immunosuppressed; cognitive impairment due to RT, poor outcome
How often do people with systemic cancer get brain metastasis? (%)
Subfalcine herniation (def) and presentation
Herniation under falx: headache, contralateral leg weakness (not very serious)
Uncal herniation puts pressure on _________, producing ____________ (ipsi or contralateral? What's the final symptom (ipsi or contralateral)? Will a patient be awake? Why?
Midbrain; contralateral hemiparesis; ipsilateral IIIrd nerve palsy; no, loss of consciousness due to distortion of ARAS in midbrain
What is a strange consequence of an uncal herniation? This is what kind of sign?
Kernohan notch: herniation pushes against OPPOSITE edge of tentorium ipsilateral paresis; "false localization" sign
Central herniation causes what kind of deterioration...
Rostro-caudal deterioration (one brainstem syndrome after another)
Cerebellar tonsils can herniate into...bad when?
Foramen magnum; Coma and death result when these herniations compress the brain stem.
So...four herniation syndromes?
Subfalcine, central, uncal, cerebellar tonsillar
How do we treat herniation?
First: remove lesion then treat cerebral edema
Types of cerebral edema
Vasogenic, cytotoxic, interstitial, osmotic
Vasogenic edema; treatment?
Breakdown of BBB; steroids
BBB intact, problem in cellular functioning
Wilderness medicine! Important cytotoxic edema point
Altitude can cause cytotoxic edema
Interstitial edema seen in? Treatment:
Seen in obstructive HC; SHUNT