neuro-CNS tumors Flashcards
most common CNS malignancies…
1. “Metastases are the most common CNS malignancy” – (lung most common, breast, kidney, GI) 2. Of intrinsic, gliomas most common Others: CNS lymphoma, meningiomas, Infectious (e.g. in AIDS patients)
how do CNS tumors present?
All due to mass effect on specific areas of brain, or increasing intracranial pressure
- Progressive headache/ nausea
- Cranial nerve involvement
- Seizures, sensorimotor changes
- Cognitive impairment
- Visual field changes
- Brainstem or uncal herniation leading to sudden death
what is an uncal herniation?
cerebellar tentorium (white area above cerebellum- seperates cerebral cortex from cerebellum) - uncal- pushes past this tenorium - can cause death
from temporal lobe herniating down into the brain stem
hemispheric and central diencephalic tumors cause…
Hemispheric and central diencephalic tumors – focal motor deficits occur in ~40%
hypothalamic tumors cause…
Hypothalamic tumors – neuroendocrine abnormalities, may impinge on the optic chiasm –>visual deficits
astrocytoma in the cerebellum, brain stem, visual pathway cause…
Astrocytomas of the cerebellum – weakness, tremor, ataxia
Astrocytomas of the brain stem – isolated cranial nerve deficits and contralateral hemiparesis
Astrocytomas of the visual pathways – strabismus, proptosis, nystagmus, or developmental delay
astrocytoma in the spinal cord causes…
Astrocytomas of the spinal cord – pain localized to the vertebral segments adjacent to the tumor, weakness, gait disturbance, and sphincter dysfunction; paresthesias and loss of sensation occur later in the disease course
intramedullary vs extramedullary spinal cord tumors
Intramedullary ~10%- arise from inside the spinal cord:
-Ependymoma most common intramedullary tumor; the remainder are other types of glioma
Extramedullary may be extradural or intradural
neurofibromas and meningiomas are relatively common, are benign, and may be intradural or extradural
…others are usually extradural
___ of pts with a brain tumor complain of what first?
1/3, HA … a progressive headache disorder or the new onset of headaches in middle or later life merits investigation if no cause is apparent
Dx of CNS tumor
- MRI (bony artifacts complicate CT)
- angiography: for solid mass vs aneurysm
- brain biopsy
txt of brain tumor
Oncology, neurosurgery consults
Surgery, irradiation, chemotherapy, depending on tumor type
primary intracranial tumors
Most common/malignant
Glioblastoma multiforme (GBM) is the most common and most aggressive of the primary brain tumors
-in kids: medulloblastoma & brainstem glioma
-ependymoma
pseudotumor cerebri - what is it? symptoms? who does it effect?
“Idiopathic Intracranial Hypertension” (better term for this) -mild HAs
-Increase in CSF production/decrease in absorption= increased pressure
-optic nerve atrophy and visual loss (papilledema)
Mostly affects obese women of childbearing age (20x more common)
pseudotumor cerebri signs? early vs later
Early:
Headache, diplopia, visual complaints
Later:
Limited abduction from increased ICP
Visual loss, starting in inferior nasal visual fields
txt pseudotumor cerebri?
lower ICP and CSF volume, treat papilledema
- Acetazolamide decreases CSF production
- Steroids
- Weight loss
- Serial LPs to remove CSF pressure
- **Peritoneal shunts, optic nerve sheath fenestration to relieve pressure
