Mass Lesions (1Q)

Question 1

Most common herniation disturbance in brain tumor:

Answer 1

Herniation of temporal lobe uncus through tentorial hiatus- causes compression of CN III, midbrain, and posterior cerebral artery. Earliest sign is ispsilateral pupillary dilation.

Question 2

Frontal lobe lesion/tumor signs

Answer 2

Personality changes, intellectual decline, contralateral grasp reflex. If left inferior frontal gyrus is involved expressive aphasia may occur. Anosmia occurs if CNI is compressed. Focal motor siezures.

Question 3

Temporal lobe lesion/tumor signs

Answer 3

Seizures, olfactory/gustatory hallucinations, licking/smacking lips, sensations of deja vu, depersonalization, auditory hallucinations. L sided lesions cause receptive aphasia.

Question 4

Parietal lobe lesion/tumor signs

Answer 4

Contralateral disturbances of sensation, sensory seizures, sensory loss or inattention. Astereognosis is also present.

Question 5

Occipital lobe lesion/tumor signs

Answer 5

Crossed homonymous hemianopsia or partial field defect. If involvement is bilateral, may cause cortical blindness were pupillary reflexes are intact.

Question 6

Brainstem and cerebellar lesion/tumor signs

Answer 6

Crainial nerve palsies, ataxia, incoordination, nystagmus, pyramidal and sensory defects of limbs on one or both sides.

Question 7

Medullablastoma

Answer 7

seen most frequently in children. Causes increased intracranial pressure and brainstem/cerebellar signs. Tx is surgery+radiation+chemo.

Question 8

Which primary tumors occur in children?

Answer 8

Medulloblastoma, brainstem glioma, craniopharyngioma,

Question 9

This brain tumor is associated with HIV and immunodeficient statuses:

Answer 9

Primary cerebral lymphoma - Tx is high dose methotrexate+radiation.

Question 10

Preferred imaging modality for suspected brain tumor:

Answer 10

MRI w/ gadolinium enhancement.

Question 11

Other modalities that are useful in workup of brain tumor:

Answer 11

EEG may show focal disturbances or diffuse changes.

Question 12

Meningioma

Answer 12

Most common tumor. Usually benign. Increasing likelihood with aging. Treatment is surgical.

Question 13

In general, which tumors can be resected surgically?

Answer 13

Benign or asymptomatic tumors (meningiomas), or symptomatic tumors that are extra-axial or are not in critical/inaccessible areas.
Surgical shunting can reduce pressure causing hydrocephalus.

Question 14

Which tumors benefit most from radiation therapy?

Answer 14

Malignant gliomas. Others depend on their acessibility and feasibility of complete surgical removal.

Question 15

What are the uses of chemotherapy in treating brain tumors? Which agents are used? How about for cerebral edema/herniation?

Answer 15

Gliomas tend to respond well. Temozolomide is commonly used as are monoclonal antibodies.
Corticosteroids reduce cerebral edema.
Herniation dextramethasone and IV mannitol.

Question 16

What are the most common sources of intracranial metastases?

Answer 16

1. Lung
2. Breast
3. Kidney
4. Skin
5. GI tract

Question 17

Leptomeningeal metatstases

Answer 17

neoplasms metastasizing to leptomeninges (usually carcinoma of breast, lymphoma, an dleukemia). Causes multifocal neurologic defects associated with ifiltration of cranial and spinal nerve roots. Dx is by examination of CSF showing increased pressure, pleocytosis, increased protein, and decreased glucose w/ or w/o malignant cells.

Question 18

Primary cerebral lymphoma

Answer 18

complication in AIDS patients leading to disturbances in cognition/consciousness, focal motor/sensory defects, aphasia, seizures, cranial neuropathies.
Clinical sx are identical to both crebral toxoplasmosis AND cryptococcal meningitis, though CT is normal in CM.

Question 19

Origin of mets to spinal cord:

Answer 19

prostate, breast, lung, kidney

Question 20

spinal cord tumor: Sx

Answer 20

Insidious development of pain aggravated by coughing or straining. May be radicular, localized to back, or felt diffusuely in extremity. Motor deficits, paresthesias, numbness, especially in the legs. Bladder, bowel, sexual dysfunction.
**Lower motor neuron signs below level, upper motor neuron signs above.

Question 21

spinal cord tumor: imaging, lab

Answer 21

MRI with contrast or CT myelography.

Question 22

spinal cord tumors: tx

Answer 22

Decompression and surgical excision (where feasible), or irradiaiton. If 2ndary- irradiation is Tx of choice.