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Flashcards in Neoplasms and ALS Deck (57):
1

How does a brain tumor commonly present?

subacute progression of focal neurological deficit
seizure
nonfocal neurological deficit

2

Subacute progression of focal neurological deficit d/t?

the tumor pressing down on the white matter

3

Seizure d/t?

disruption of neuronal circuits

4

Nonfocal neurological deficit - sx?

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

5

HA types from nonfocal neurological deficit?

recumbency
increased ICP

6

Recumbency HA?

worse when resting
d/t displacement of pain-sensitive structure

7

Increased ICP HA?

happens many times a day
fast on, fast off

8

Brain tumor - tx?

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

9

What do watch out for Dexa?

Cushing's dz

10

What is a primary brain tumor?

glioma

11

What is glioma?

any brain tumor that arises from glial cell

12

What are the different types of glioma?

CNS lymphoma
Oligoendroglimoa
Meningioma
Ependyoma
Pituitary tumor
Astrocytoma
Schwannaoma
Pnet

13

What is the most common brain tumor?

astrocytoma

14

Astrocytoma - pathophysio?

damages the brain tissues first

15

Astrocytoma - prognosis?

not good - cannot excise entirely

16

Astrocytoma - histological grades?

Grade I - IV (low and high)

17

Astrocytoma - low grade?

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

18

Astoryctoma - high grade?

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

19

Subtype of astrocytoma?

glioblastoma/glioblastoma multiforme

20

Astrocytoma -tx?

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

21

Oligodendraglioma - prognosis?

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

22

Ependymomas - location?

intracranially
spinal cord (filum terminale)

23

Ependymomas - tx?

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

24

Medullablastoma and primitive neuroectodermal tumors?

DEADLY AND AGGRESSIVE

25

Medullablastoma and primitive neuroectodermal tumors - location? population?

posterior fossa; neural precurosr cell
children

26

CNS lymphomas - types?

primary
secondary

27

CNS lymphomas primary - population?

immunocompromised patients - HIV pts
poor prognosis

28

CNS lymphomas secondary - population?

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

29

CNS lymphomas primary and secondary - tx?

systemic chemo
intrathecal chemo/radiation

30

Meningioma?

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

31

Meningioma - population?

females
mid age

32

Meningioma - areas?

sagittal sinus
cerebellar pontine
dorsum of spinal cord

33

Schwannoma?

arises from schwan cells

34

Schwannoma - area?

8th CN - acoustic
aka vestibular schwannnoma

35

Schwannoma - sx?

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

36

Schwannoma - tx?

excision
hearing is lost

37

Pituitary tumor/adenoma?

benign tumor

38

Type of pituitary tumor/adenoma?

carniopharyngioma

39

Carniopharyngioma?

arises from Rathke's pouch

40

Carniopharyngioma - sx?

HA
visual field defect
hypopituitarism

41

What are secondary/metastatic brain tumors?

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

42

Secondary/metastatic brain tumors - most common?

lung
breast
melanoma
renal cancer
colon cancer

43

Secondary/metastatic brain tumors - tx?

glucocorticosteroids
anticonvulsants
surgery
radiation/chemo

44

What is neurofibromatosis?

benign peripheral nerve tumors
schwann cells + fibroblasts

45

Type I von recklinghausen disease?

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

46

Tuberous sclerosis?

INHERITED
cutaneous lesions on the skin

47

Morton's neuroma?

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

48

Morton neuroma - sx?

burning
something stuck in shoe

49

Morton neuroma - tx?

footwear change
steroid injection
neuroablation
surgical excision

50

What is ALS?

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

51

What is the prognosis of ALS?

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

52

ALS - population?

40-60 yrs

53

ALS - sx?

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

54

ALS - what is spared?

occular muscles
bladder, bowel, sexual fxn

55

ALS - PE?

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

56

ALS - dx?

expert needed
MRI may be used to r/o

57

ALS -tx?

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