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Neuro-Oncology Flashcards

1
Q

Frontal Cortex Tumor Presentation (7)

A
  • Personality changes: disinhibition/irritability
  • Seizures
  • Hemiparesis (weakness one side of body)
  • Urinary urgency and frequency
  • Gait ataxia
  • Aphasia (more pronounced if the tumor is on the left)
  • Gaze preference (deviates away from the lesion)
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2
Q

Temporal Cortex Tumor Presentation (3)

A
  • Seizure
  • Memory disturbance
  • Superior quadrantanopia (anopia affecting only a quarter of the visual field)
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3
Q

Parietal Cortex Tumor Presentation (4)

A
  • Hemianesthesia (anesthesia of one side of the body)
  • Aphasia
  • Neglect (if on the non-dominant side of the brain)
  • Constructional apraxia (cannot put pictures together)
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4
Q

Occipital Cortex Tumor Presentation (3)

A
  • Hemianopia
  • Visual agnosia (not recognizing things)
  • Seizures
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5
Q

Thalamus Tumor Presentation (2)

A
  • Hemianesthesia or sensory disturbances

- Cognitive impairment

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6
Q

Brainstem Tumor Presentation (4)

A
  • Cranial Neuropathies
  • Ataxia
  • Weakness or sensory disturbances
  • Nystagmus
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7
Q

Pineal Region Tumor Presentation (1)

A

Parinaud syndrome: impairment of upward gaze, dissociation of the pupillary light reflex and the near reflex.

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8
Q

Third Ventricle Tumor Presentation (3)

A
  • Hydrocephalus
  • Hypothalamic dysfunction
  • Autonomic Dysfunction
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9
Q

Cerebellum Tumor Presentation (4)

A
  • Headache
  • Ataxia
  • Hydrocephalus
  • Dizziness/ Nausea
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10
Q

What is a focal neurological deficit?

A

Symptoms that come from a focal area.

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11
Q

Do brain tumors usually present with focal deficits?

A

Depends on the tumor.

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12
Q

If you have a patient with a headache and a focal neurological deficit of short duration, what study do you order?

A

CT

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13
Q

If you have a patient with a headache and a chronic focal neurologic deficit, what study should you order?

A

MRI

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14
Q

Papilledema, focal or non-focal?

A

Non-focal, it is a sign of increased ICP

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15
Q

Hemiparesis, focal or non-focal?

A

Focal, the tumor is on the opposite side of the paresis. Lesion of the motor cortex

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16
Q

Headache, focal or non-focal?

A

Non-focal

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17
Q

Hyperreflexia, focal or non-focal?

A

Non-focal, it is generalized

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18
Q

Unilateral Hyperreflexia, focal or non-focal?

A

Focal, can be blamed on a lesion

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19
Q

Nausea, focal or non-focal?

A

Non-focal, but it can be a symptom of a focal lesion

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20
Q

Aphasia, focal or non-focal?

A

Focal

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21
Q

Astrocytoma (4)

A
  • Most common primary brian tumor
  • 4 grades, all good prognosis
  • Better prognosis than glioblastoma multiform
  • The first symptom in two-thirds of patients is a seizure
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22
Q

Glioblastoma Multiforme (3)

A
  • Variegated (different colors) appearance, large, infiltrative, sometimes multifocal
  • Untreated, <20% survive one year
  • May be calcification changes, with surrounding edema
23
Q

Oligodendroglioma (4)

A
  • More benign and slow growing
  • Often calcified or cystic
  • May have a component of astrocytoma
  • Certain genetic varieties have a better response to chemo and a better prognosis
24
Q

How do you diagnose a glioma tumor?

A
  • Examine the patient first!
  • MRI with contrast for:
    1. Astrocytoma
    2. Gliioblastoma Multiforme
    3. Oligodendroglioma
25
How do you treat a glioma? (4(
- Usually surgical followed by radiation - Surgical de-bulking prolongs survival (just taking out some of the tumor) - Corticosteroids before/after - Anticonvulsants if seizures are present
26
Ependymoma Tumor (3)
- Most common site is the 4th ventricle - Most common glioma of spinal cord - Presentation depends on location
27
What is the diagnosis/treatment/prognosis for ependymoma Tumors? (3)
Diagnosis: CT/MRI Tx: Surgical + Radiation Prognosis: survival depends on degree of anaplasia and surgical accessibility, variable!
28
Metastatic Tumors (3)
- More common than primary tumors - Hematogenous spread - Common from the lung, breast, melanoma, GI, thyroid and kidney
29
Metastatic Tumor Presentation (7)
- S/S: seizures, headache, focal weakness, mental and behavioral derangements, ataxia, aphasia and increased ICP
30
Metastatic Tumor Diagnosis
- CT with and without contrast | - Multiple nodular deposits
31
Metastatic Tumor Tx/Prognosis (5)
- Surgery if the tumors are solitary and accessible - Radiation - Chemo - Corticosteroids - Prognosis: usually poor
32
Meningioma (4)
- Originates from dura mater or arachnoid - More common in elderly - M>F 2:1 - Generally supratentorial, slow growing
33
Meningioma Prognosis/treatment/diagnosis
- Diagnosis: MRI - Tx: surgical, then radiation if it is incompletely removed or if there are malignant characteristics - Prognosis: good
34
Where are most primary tumors located in adults?
Supratentorial
35
Where are most primary tumors located in kids?
Brainstem and Cerebellum
36
Acoustic Neuroma Facts
- "Vestibular Schwannoma" typically affects the vestibular branch of the CN VIII - Can occur as part of von recklinghausen neurofibromatosis genetic disorder where tumors grow on nerves)
37
Acoustic Neuroma Presentation (8)
- Unilateral hearing loss - Other CN deficits like facial pain (CN VII) - Headache - Constant dizziness - Unsteady gait - Tinnitus - Facial Weakness - Disturbance of taste
38
Acoustic Neuroma PE (5)
- CN exam: V, VII, VIII, XI, XII - Gait abnormality - Unilateral ataxia of limbs - Inequality of reflexes - Signs of increased ICP (<25%)
39
Acoustic Neuroma Testing/Diagnosis (4)
- CT with contrast will pick up tumors >2cm - MRI with gadolinium contrast will pick up smaller tumors - Audiology and vestibular testing - CSF protein is elevated in 2/3rd of pts, even if they are silent lesions
40
Acoustic Neuroma Tx (4)
Surgical Excision - Hearing can be preserved in 1/3rd of pts with tumors smaller than 2.5cm - Intraoperative monitoring of brainstem auditory responses and facial nerve EMG Focused radiation/Gamma Knife -preferred for older patients and with reoccurrence - better preservation
41
Pituitary Adenoma (7)
- Effect visual fields before endocrine - Age linked - Many are prolactin secreting adenomas - 10-15% secrete ACTH - 33% are non-functioning (doesn't affect pituitary) - Very rare to have them secrete TSH or gonadotropins - Can affect one or many hormones
42
Pituitary Adenoma Presentation (5)
- Complete/partial bitemporal hemianopia - May extend to cavernous sinus and develop ocular motor palsies - Females: amenorrhea-galactorrhea syndrome (produce breast milk) - Acromegaly (broad shoulders, large jaw etc.) - Cushings disease (ACTH, endogenous)
43
How do you test for prolactin? (4)
- Serum prolactin level - chlorpromazine test - TRH provocative test - L-dopa suppression
44
Pituitary Adenoma Diagnosis/Testing (2)
- MRI with gadolinium (3mm) | - Plus endocrine testing
45
Pituitary Adenoma Treatment (4)
- Prolactinomas: bromocriptine - Acromegaly: ocreotide - Surgery for those intolerant, or unresponsive tumors - Incomplete removal is followed by radiation
46
Craniopharyngioma (3)
- Benign epithelioid tumor - Compresses optic chiasm - Once they are bigger than 3cm they are usually cystic and have some calcification
47
Craniopharyngioma Presentation (3)
- Common in children, can happen in adults - Increased ICP - Combined pituitary, hypothalamic, chiasmal derangement
48
Craniopharyngioma Diagnosis/Testing (2)
- MRI most useful | - If cyst ruptures, can cause aseptic meningitis (decreased glucose in the CSF)
49
Craniopharyngioma Treatment (7)
- Surgical excision - Pre/Post op steroids - Close monitoring, control of temp., water balance Palliative - Stereotactic aspiration - Focused radiation - Ventricular shunting - Endocrine replacement
50
Carcinomatous Meningitis (5)
- Spinal cord tumor - Widespread dissemination of tumor cells in CSF - Diagnose by CSF, may have to repeat LPs to get copious CFS - Rare, very bloody CSF - Poor prognosis
51
Leukemia (6)
- Spinal cord tumor - Leukemic cells found in the CSF - Treatment includes: - Radiation - Intrathecal or IV methotrexate - Complication: necrotizing leukencephalopathy
52
Lymphoma (2)
Complication: - extradural compression of the spinal cord or caudal equina - results from extension from vertebrae or lymph node of the tumor
53
Cauda Equina Syndrome (7)
- Saddle anesthesia - Loss of rectal tone - loss of bowel/bladder control - leg weakness - back pain/leg pain - sexual dysfunction - surgical emergency!!!

Neurology (12 decks)

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