Neoplasms and ALS

Question 1

How does a brain tumor commonly present?

Answer 1

subacute progression of focal neurological deficit
seizure
nonfocal neurological deficit

Question 2

Subacute progression of focal neurological deficit d/t?

Answer 2

the tumor pressing down on the white matter

Question 3

Seizure d/t?

Answer 3

disruption of neuronal circuits

Question 4

Nonfocal neurological deficit - sx?

Answer 4

HA
dementia
personality disorders (esp if in the frontal lobe)
gait disturbances (cerebellar)
increased ICP
N&V

Question 5

HA types from nonfocal neurological deficit?

Answer 5

recumbency

increased ICP

Question 6

Recumbency HA?

Answer 6

worse when resting

d/t displacement of pain-sensitive structure

Question 7

Increased ICP HA?

Answer 7

happens many times a day

fast on, fast off

Question 8

Brain tumor - tx?

Answer 8

symptomatic care
glucocorticoids- decrease edema (Dexa)
antiseizure (Keppra)
radiation

Question 9

What do watch out for Dexa?

Answer 9

Cushing’s dz

Question 10

What is a primary brain tumor?

Answer 10

glioma

Question 11

What is glioma?

Answer 11

any brain tumor that arises from glial cell

Question 12

What are the different types of glioma?

Answer 12

CNS lymphoma
Oligoendroglimoa 
Meningioma
Ependyoma
Pituitary tumor
Astrocytoma
Schwannaoma
Pnet

Question 13

What is the most common brain tumor?

Answer 13

astrocytoma

Question 14

Astrocytoma - pathophysio?

Answer 14

damages the brain tissues first

Question 15

Astrocytoma - prognosis?

Answer 15

not good - cannot excise entirely

Question 16

Astrocytoma - histological grades?

Answer 16

Grade I - IV (low and high)

Question 17

Astrocytoma - low grade?

Answer 17

children> adults
cerebellum
grade I has good prognosis AFTER excision
grade II has 5-6 yr survival AFTER excision

Question 18

Astoryctoma - high grade?

Answer 18

adult> children
supratentorium
grade IV astrocytoma: survival <1yr

Question 19

Subtype of astrocytoma?

Answer 19

glioblastoma/glioblastoma multiforme

Question 20

Astrocytoma -tx?

Answer 20

if not able to surgically remove (like high grade) - symptomatic:
glucocorticosteroids- Dexa
antiseizure - Keppra
radiation/chemo

Question 21

Oligodendraglioma - prognosis?

Answer 21

a little benign- actually have a chance at surviving (longer life expectancy): excisable and respond well to chemo

Question 22

Ependymomas - location?

Answer 22

intracranially
spinal cord (filum terminale)

Question 23

Ependymomas - tx?

Answer 23

excision; if able to? good prognosis - but usually deadly

Question 24

Medullablastoma and primitive neuroectodermal tumors?

Answer 24

DEADLY AND AGGRESSIVE

Question 25

Medullablastoma and primitive neuroectodermal tumors - location? population?

Answer 25

posterior fossa; neural precurosr cell | children

Question 26

CNS lymphomas - types?

Answer 26

primary | secondary

Question 27

CNS lymphomas primary - population?

Answer 27

immunocompromised patients - HIV pts | poor prognosis

Question 28

CNS lymphomas secondary - population?

Answer 28

B cell lymphoma pts or B cell leukemia who have tumor of the bone, bone marrow, cranial sinus

Question 29

CNS lymphomas primary and secondary - tx?

Answer 29

systemic chemo | intrathecal chemo/radiation

Question 30

Meningioma?

Answer 30

benign tumor that starts at the mesoderm (attached to dura) and make it's way into the brain

Question 31

Meningioma - population?

Answer 31

females | mid age

Question 32

Meningioma - areas?

Answer 32

sagittal sinus cerebellar pontine dorsum of spinal cord

Question 33

Schwannoma?

Answer 33

arises from schwan cells

Question 34

Schwannoma - area?

Answer 34

8th CN - acoustic | aka vestibular schwannnoma

Question 35

Schwannoma - sx?

Answer 35

unilateral hearing loss | +/- compress facial nerve (CN VII) - facial palsy

Question 36

Schwannoma - tx?

Answer 36

excision | hearing is lost

Question 37

Pituitary tumor/adenoma?

Answer 37

benign tumor

Question 38

Type of pituitary tumor/adenoma?

Answer 38

carniopharyngioma

Question 39

Carniopharyngioma?

Answer 39

arises from Rathke's pouch

Question 40

Carniopharyngioma - sx?

Answer 40

HA visual field defect hypopituitarism

Question 41

What are secondary/metastatic brain tumors?

Answer 41

cancer starts from somewhere else but makes it's way up to the brain

Question 42

Secondary/metastatic brain tumors - most common?

Answer 42

``` lung breast melanoma renal cancer colon cancer ```

Question 43

Secondary/metastatic brain tumors - tx?

Answer 43

glucocorticosteroids anticonvulsants surgery radiation/chemo

Question 44

What is neurofibromatosis?

Answer 44

benign peripheral nerve tumors | schwann cells + fibroblasts

Question 45

Type I von recklinghausen disease?

Answer 45

type of neurofibromatosis cafe au lait spots freckles in NON EXPOSED spots nothing until it cxs radiculopathy

Question 46

Tuberous sclerosis?

Answer 46

INHERITED | cutaneous lesions on the skin

Question 47

Morton's neuroma?

Answer 47

neuroma of plantar nerve (3rd and 4th metatarsal)

Question 48

Morton neuroma - sx?

Answer 48

burning | something stuck in shoe

Question 49

Morton neuroma - tx?

Answer 49

footwear change steroid injection neuroablation surgical excision

Question 50

What is ALS?

Answer 50

progressive weakness and paralysis of VOLUNTARY muscles | death of both UMN and LMN

Question 51

What is the prognosis of ALS?

Answer 51

not good - pneumonia will kill them b/c they cannot cough up the phlegm 3-5 yrs of survival

Question 52

ALS - population?

Answer 52

40-60 yrs

Question 53

ALS - sx?

Answer 53

insidious NO PAIN AND NO SENSORY LOSS limb weakness first >>> painless difficulty turning keys/buttons (dexterity) speech/swallowing difficulties

Question 54

ALS - what is spared?

Answer 54

occular muscles | bladder, bowel, sexual fxn

Question 55

ALS - PE?

Answer 55

LMN - weakness, atrophy, fasciculation | UMN - hyperreflexia, babinski sign spasticity

Question 56

ALS - dx?

Answer 56

expert needed | MRI may be used to r/o

Question 57

ALS -tx?

Answer 57

``` nothing baclofen for spasms family counsel +/- vent/tracheostomy +/-gastrostomy PT ```