Neurology II

Question 1

List 3 closed head injuries

Answer 1

1) Concussion
2) Post concussion syndrome
3) Traumatic brain injury (TBI)

Question 2

1) What typically refers to moderate to severe head trauma leading to functional and structural dysfunction?
2) What is a mild TBI with functional disturbance but with preserved structure?

Answer 2

1) TBI
2) Concussion

Question 3

1) Define concussion.
2) What may it result in?

Answer 3

1) Head injury resulting in altered consciousness < 6 hrs. Usually, recover in seconds to minutes.
2) Retrograde and anterograde amnesia around the time of the event

Question 4

Concussion:
1) Pathophys?
2) Epidemiology?
3) Etiologies?

Answer 4

1) Acceleration/deceleration movements of the head cause stretching and shearing of axons result in LOC at moment of impact (transient dysfunction of upper brainstem reticular activating system)
2) ~3 mil/ yr thought that about ½ aren’t reported
3) Trauma, sport, recreation

Question 5

Concussion:
1) What are some DDxs?
2) What are some Txs?

Answer 5

1) HA, seizure, meningitis, encephalitis, infection, drug toxicity
2) ABCs, Supplemental O2, tight BP control, repeat neuro checks, rest

Question 6

What are 3 sideline assessment tools for concussion?

Answer 6

1) Sports concussion assessment tool 6 (SCAT6) – validated for age 13+
2) Child SCAT6: validated for kids 5-12 y/o
-Validated during acute phase, less utility 3-5 days post-injury, widely utilized
-The incorporated symptoms checklist may be useful for monitoring recovery
3) Canadian CT
-Not used <16

Question 7

What can’t assess concussion under 16?

Answer 7

Canadian CT

Question 8

1) Describe concussion Tx.
2) Are there any specific meds?

Answer 8

1) Individualized and based on symptom presentation
Brief period of rest followed by gradual return to activity
2) No specific medications; Rx for symptom management same as in patients without concussion

Question 9

Concussion:
1) How long should the acute rest period last? Then what should you do?
2) What leads to better outcomes?

Answer 9

1) ~4-48 hours is appropriate, then symptom limited cognitive and physical activity should be introduced
2) Early symptom limited activities

Question 10

Concussion:
1) When should a pt return to activity?
2) What should you tell the pt after the initial rest period?
3) When may they return to full activities?

Answer 10

1) Individualized return to activity
2) Encourage to return to normal ADLs as tolerated
3) May return to full activities once fully recovered (ADLs) and not taking any symptomatic medications

Question 11

Concussion: After initial 24-48 hours of acute rest, what should the pt do?

Answer 11

1) Cognitive activities at home with frequent breaks – should not worsen symptoms
2) Light physical activity that does not worsen symptoms or pose risk for repeat injury – walks

Question 12

Concussion:
1) When the pt resumes part time school/work with expectation to resume full time school/work, what may be needed?
2) When can a pt restart their sport?

Answer 12

1) +/- short term accommodations
2) Once return to full time school/work without accommodation, asymptomatic, caught up on academics: return to play protocol with medical supervision

Question 13

Concussion:
1) When do Sx typically present?
2) What is important in Tx?
3) When do they often resolve?

Answer 13

1) Symptoms typically present immediately
-Can be delayed by minutes to hours
2) Serial monitoring important
3) In 72 hours

Question 14

When do most ppl recover from concussion?

Answer 14

Most adults fully recover by 2 weeks and kids within 4 weeks

Question 15

Which of the following is the keystone to management of concussions?
A. medication for symptoms
B. brief rest from cognitive and physical activity
C. hospitalize for monitoring
D. STAT neuroimaging

Answer 15

B. brief rest from cognitive and physical activity

Question 16

Post Concussion Syndrome:
1) What is it
2) What are the Sx?
3) What may the neuro exam/ imaging look like

Answer 16

1) 40 % of patients with concussion (but not necessarily LOC) will have lingering symptoms for a few weeks to years.
2) HA, dizziness, fatigue, insomnia, hypersomnia, blurred vision, tinnitus, irritability, restlessness, inability to concentrate, anxiety, depression.
3) Neuro exam and imaging may be normal

Question 17

Post Concussion Syndrome:
1) What may happen over time?
2) Who is more likely to experience this?
3) What is the pathophys?

Answer 17

1) Affected area of brain may atrophy and result in symptoms c/w that specific lobe.
2) Patients with baseline psych disorders
3) Cerebral contusions, diffuse axonal injury

Question 18

PCS (post concussion syndrome):
1) Etiology?
2) Epidemiology?
3) DDxs?
4) Txs?

Answer 18

1) Head
2) 40% of patients with concussions will have PCS
3) Depression, ADHD, behavioral conditions, malingering, emotional lability, anxiety, sleep disorders
4) Gradual improvement many months
anxiolytics, antidepressants, cognitive and vocational therapy

Question 19

Traumatic Brain Injury (TBI):
1) What does a TBI require?
2) What are the Sx?
3) What does imaging reveal?
4) What is it a major cause of?

Answer 19

1) Evidence of trauma
2) Focal neurologic deficits with progressive mass effect; delayed inflammatory response can be delayed 1-3d
3) Skull fracture, intracranial bleed and/or cerebral edema
4) Death and disability

Question 20

What is the pathophys of TBIs?

Answer 20

Depends on cause; tissue destruction, perivascular edema, contusional or perivascular bleeding within the cerebral parenchyma, and hypoxic-ischemic brain injury may develop secondarily.

Question 21

TBI:
1) Epidemiology?
2) Etiologies?
3) 2 DDxs?

Answer 21

1) Incidence is rising 2/2 increasing MVAs in low- middle-income countries as well as increasing falls in the aging population; ~ 2 mil patients with TBIs treated in US EDs/yr; peak age 15–25-year-olds; leading cause of death in people <25. M»>F
2) MVAs, GSW, crush or blast injuries
3) Stroke or spontaneous intracranial hemorrhage

Question 22

TBI Txs?

Answer 22

1) ABCs, eval and stabilize C spine, fluids, GCS (intubate <8)
2) ? Supplemental O2, strict control of BP, frequent neuro checks, assess for other sites of trauma, reduce ICP,? CSF leak? (Halo sign,) pupils? CT/MRI, reverse any comorbid factors as able (ex/ coagulopathy,) monitor for infections, seizures, PTSD

Question 23

How do you stratify the risks of pts with TBIs?

Answer 23

1) Low/Moderate: GCS = >15 (alert, fully oriented and following commands) and CT neg ; may d/c home with close observation
2) Mod: GCS 9-14, CT findings do not require surgery; admit to ICU for close observation/neuro checks and repeat CT in 24 hrs
3) High: GCS <=8 serious head injury admit to ICU for neurosurgical consultation; stabilize patient, intubate; do not delay surgery as time is brain cells

Question 24

A 27 y/o male patient presents with h/o Ha, 2-3 times a month, lasting from 30 minutes to several days, bilateral band-like quality, mild to moderate intensity, not aggravated by routine physical activity (walking or climbing stairs). Denies N/V but does endorse some sensitivity to noise. Some improvement noted with Excedrin migraine tablets. Remainder of ROS & PMHx is non-contributory. PE non-focal

Dx?
A. tension headache
B. migraine headache
C. cluster headache
D. secondary headache

Answer 24

A. tension headache

Question 25

38 y/o male presents with h/o of disabling pain behind his right eye lasting about 60 minutes. He notes his eye gets red and tears and he becomes very agitated. Occurs several times a day for a couple of weeks then seems to go away for months then can return. HA gets worse with any activity. Remainder of ROS, PMHx is non-contributory. PE is non-focal Dx? A. tension headache B. migraine headache C. cluster headache D. secondary headache

Answer 25

C. cluster headache (no CT needed)

Question 26

Ataxia: 1) Define it 2) Pathophys? 3) Epidemiology?

Answer 26

1) Disordered coordination of movements (often thought of as gait) 2) Typically: cerebellar dysfunction, other lesions of nervous system, proprioception, and/or vestibular system 3) Uncommon, 150,000 people in US

Question 27

Ataxia: 1) Etiologies? 2) DDxs? 3) Tx?

Answer 27

1) Acute infections, post-inflammatory, toxins, tumors, trauma, migraines, BPPV, Guillain–Barré 2) Above etiologies 3) Treat underlying cause

Question 28

Essential tremor: 1) How does it typically present? 2) Is it fast or slow onset? Explain 3) DDxs?

Answer 28

1) Typically involves the bilat hands and is brought about by intentional movements, ex/ drinking/eating, writing, tying shoes 2) Slowly progressive and can also involve the head, voice and legs 3) Parkinson’s Dz, dystonic or orthostatic tremors, hyperthyroidism

Question 29

Essential tremor: 1) Pathophys? 2) Epidemiology? 3) Etiology?

Answer 29

1) Pathophys: dysfunction of cerebellar – brainstem-thalamic–cortical circuits 2) Most common cause of action tremor in adults, < 1 % worldwide, 5% of adults > 60 M= F 3) Unknown, but thought to be cerebellar dysfunction or genetic

Question 30

What is the goal of treating essential tremor? How do you Tx?

Answer 30

**To minimize tremor enough to prevent disruption of ADLs:** 1) Typically, in primary care, **d/c caffeine and any aggravating meds** -exclude secondary causes 2) **Propranolol or primidone** (B Blockers have central depressive effect; primidone works to increase GABA) 3) **Refer to neurology if not comfortable** treating it

Question 31

Essential tremor: 1) What may Sx be aggravated by? 2) What can make Sx better?

Answer 31

1) Stress, fatigue, caffeine, temperature extremes 2) Alcohol

Question 32

Parkinson's disease: 1) Define it 2) What is the pathophys? 3) Epidemiology?

Answer 32

1) Adult-onset neurodegenerative disorder with slow progression 2) Dopamine depletion (disrupts thalamus and motor cortex connections) 3) 90,000 new cases/yr; rising as population ages M>F >10 mil PD patients worldwide

Question 33

Parkinson's disease: What are the 3 hallmark features?

Answer 33

1) Pill rolling tremor at rest; often unilateral, resolves with intentional movement 2) Cogwheel rigidity 3) Bradykinesia/shuffling gait and freezing movements

Question 34

Parkinson's disease: 1) Etiology? 2) How is it diagnosed? DDxs? 3) Tx goal? What are some Txs?

Answer 34

1) Genetic, lower lifetime estrogen exposure, exposure to environmental toxins 2) Clinical diagnosis (though clinical response to levodopa is diagnostic); hydrocephalus, trauma, tumor, toxins, or metabolic imbalance 3) Symptom control; can't cure -Dopaminergic meds

Question 35

Parkinson's disease: 1) Assoc. Sx? 2) Non-motor Sx?

Answer 35

1) Along with bradykinesia: rigidity, micrographia, postural instability, shuffling gait 2) Depression, sleep disturbance, cognitive impairment, autonomic dysfunction (orthostatic hypotension, urinary urgency, constipation, excessive sweating)

Question 36

List 2 medications that can Tx Parkinson's, and what group of meds each is in

Answer 36

1) Levodopa-Carbidopa (Sinemet; dopamine agonist) 2) Benztropine Mesylate (anticholinergic (indirectly increases dopamine))

Question 37

Which part of Levodopa-Carbidopa (Sinemet) is adjunct to reduce peripheral side effects (nausea/vomiting, dreaming, psychosis, dyskinesias) & increase CNS bioavailability of levodopa (dopamine agonist)?

Answer 37

Carbidopa

Question 38

Huntington's disease: 1) What is it? 2) Pathophys?

Answer 38

1) Involuntary and unpredictable movements of extremities that also includes dementia and behavioral changes. Gradual onset and progression. (chorea + dementia.) onset usually between ages 30-50. Progressive and fatal in 15 -20 years 2) Under-activity of GABA and acetylcholine and overactive dopamine

Question 39

Huntington's disease: 1) Define chorea 2) Epidemiology of Huntington's? 3) Etiology?

Answer 39

1) involuntary rhythmic movements - may appear purposeful; dysarthria, ataxia 2) Worldwide, all ethnic groups, 5 in 100,000 +genetic 3) Inherited genetic defect (repeat in the Huntingtin gene, too many (37) repeats is dx of HD)

Question 40

Huntington's disease: 1) DDxs? 2) Txs?

Answer 40

1) Stroke, SLE, HIV, paraneoplastic syndromes, meds, post-infectious, other causes of dementia, other genetic movement disorders, myoclonic epilepsy 2) Symptomatic, cannot be cured or halted; Tetrabenzine can help treat dyskinesia; dopamine blockers. Genetic testing of offspring should be offered with counseling

Question 41

True or false: ALL HD patients should be referred to neurology

Answer 41

True

Question 42

Tourette’s: 1) Define & describe it 2) What is the pathophys?

Answer 42

1) Chronic disorder of involuntary motor or vocal tics prior to age 21 (<11,) often assoc with ADHD and OCD. Sudden, repetitive gestures, sounds, or words; decrease with concentration 2) Thought to be dopamine hypersensitivity

Question 43

Tourette’s: 1) Epidemiology? 2) Etiology? 3) DDxs? 4) What is the goal of Tx?

Answer 43

1) Worldwide, M>>F, <=4% of general population 2) Unknown – not genetics, but familial 3) Parkinsonism, dystonia, chorea, genetic or acquired neurologic injury, trauma, infection, stroke, Huntington’s, PANDAS, transient tic disorder, other chronic tic disorders 4) Treat underlying conditions (psych) as able, goal is for “normal” life

Question 44

Tourette's: What are some Txs?

Answer 44

1) Symptomatic, behavioral therapy (habit reversal training) 2) Clonidine 3) dopamine antagonists 4) Haloperidol 5) Tetrabenzine 6) Botox if tics limited to a small area **Stimulants contraindicated** -Choose treatment with best SE profile for specific patient -Treat any underlying comorbidities (ex/ ADHD, OCD)

Question 45

Tourette’s: ____% of children with Tourette’s syndrome will have tics resolve prior to 18, but tics may return later in life

Answer 45

50%

Question 46

Restless leg syndrome (RLS): 1) What is it? Describe the feeling 2) Pathophys?

Answer 46

1) Restless legs accompanied by unpleasant sensations in the Bilat legs( arms and trunk not affected,) intolerable tingling, crawling, creeping; relieved by moving or walking; associated with IDA, uremia, peripheral neuropathy. Not cramping 2) Unknown, thought to be affected by dopamine pathways (responds to dopaminergic meds)

Question 47

Restless leg syndrome (RLS): 1) Epidemiology? 2) Etiology?

Answer 47

1) Common, affects 3-10% of populations, begins in middle age, worsens over time 2) Familial, circadian disorder, occurs in the evenings and may worsen throughout the night

Question 48

Restless leg syndrome (RLS): 1) DDxs? 2) Txs?

Answer 48

1) Akathisia, Parkinson’s, peripheral neuropathy, radiculopathy, nocturnal seizures 2) Dopaminergic agonists (ropinirole,) gabapentin, clonazepam, treat underlying cause (IDA,) optimize sleeping habits, stretching, or massage. A lifelong disorder but can typically be controlled.

Question 49

Tardive Dyskinesia: 1) Define 2) Pathophys? 3) Etiology? What in particular?

Answer 49

1) Chronic, persistent, hyperkinetic movement disorder/restlessness of face and distal extremities 2) Muscle spasms caused by DRBAs; permanent alterations in synaptic dopaminergic sensitivity 3) Iatrogenic, esp chronic exposure to agents that block central dopamine receptors (DRBAs (dopamine receptor blocking agents). ex: neuroleptics, like risperidone also metoclopramide)

Question 50

Tardive Dyskinesia: 1) Epidemiology? 2) DDxs? 3) Txs? 4) Can it be permanent?

Answer 50

1) Globally 15-50% of patients on antipsychotics 2) Huntington’s, idiopathic dystonias, chorea, facial tics 3) Early recognition; immediate gradual removal of offensive agent 4) Can be permanent; provider needs to educate patient on symptoms to watch for. >Dopamine depleting drugs (ex: tetrabenazine for depression) -Low rate of spontaneous remission, often causes permanent disability

Question 51

61-year-old male with involuntary movements of the left hand, which occur only at rest. The symptom has been obvious to his wife for two months. Exam reveals a pill-rolling tremor at rest; a significant lack of arm movement, stooped posture and shuffled gait while walking, and cogwheeling of the shoulder joints with passive ROM. 1) What is the most likely diagnosis? 2) What is it caused by? 3) How do you want to treat it?

Answer 51

1) Parkinson's 2) Dopamine depletion 3) Give dopamine meds

Question 52

Define Alzheimer’s Disease

Answer 52

Gradual progression of memory loss plus dysfunction in at least one of the following areas: a) Cognition b) Language c) Visuospatial d) Executive functions

Question 53

Alzheimer's disease: 1) Assoc Sx? 2) What is it the most common type of? 3) Epidemiology? Demographics?

Answer 53

1) Depression, insomnia, agitation, hallucinations, restlessness, lack of ability for independent ADLs 2) Dementia in the elderly 3) Incidence increases with age, 5% of people >65 -50% of people > 85, F>M

Question 54

Alzheimer's disease: 1) Etiology? 2) Protective factors? 3) DDxs?

Answer 54

1) Age, genetics, environmental and lifestyle factors (DM, stroke, vascular disease, HTN, obesity) 2) Healthy lifestyle, no smoking, education, intellectual achievement 3) Metabolic derangement, Lyme ds, syphilis, HIV, paraneoplastic syndrome, stroke, tumor, infection, hydrocephalus, Lewy Body dementia, meds, toxins

Question 55

List 4 Txs for Alzheimer's and the side effects

Answer 55

1) Cholinesterase inhibitors 2) Donepezil (but major GI and psych SE) 3) Rivastigmine patch (less GI SE) 4) Memantine (less SE)

Question 56

Meningitis- meningococcal: 1) What are the Sx? 2) What are some positive signs? 3) What will you see in CSF? 4) How do you Dx?

Answer 56

1) Fever, HA, vomiting, convulsions, delirium; neck and back stiffness, petechial rash 2) +Kernig and Brudzinski signs 3) Purulent CSF, Gm (–) diplococci. 4) Blood or csf culture (Neisseria meningitidis) 

Question 57

Meningitis- meningococcal: 1) Pathophys? 2) Epidemiology? 3) Etiology? 4) DDx? 5) Tx?

Answer 57

1) Neisseria meningitidis invades nasopharyngeal mucosa to meninges to CSF 2) Highest <1 yo, next 1-4 yo, next >85 yo 3) Neisseria meningitidis 4) Other meningeal infections (Rickettsial, echovirus, staph) 5) IV PCN G q 4hr x 5-7 d

Question 58

Encephalitis (viral): 1) What is it? 2) What is the pathophys? 2) Epidemiology?

Answer 58

1) Acute inflammation of the brain: HA, AMS with neurologic dysfunction, personality changes and hallucinations; most commonly from viruses (HSV and arthropod-born) 2) Invasion of the brain by viruses, damages neurons, can cause hemorrhagic necrosis 3) Anytime of year worldwide; 1000/yr in US during mosquito season; US, <1000/yr (except West Nile has been more common some years)

Question 59

Encephalitis (viral): 1) Etiology? 2) DDxs? 3) Tx?

Answer 59

1) HSV 1, arthropod-born viruses 2) Meningitis: bacterial, fungal, parasitic, autoimmune, meds, carcinomatous 3) HSV = IV acyclovir; West Nile = supportive (Tick-born infections must be reported to local health dept or CDC)

Question 60

What are the 2 main types of tumors? Give examples of and describe each

Answer 60

1) Primary tumors: Solitary lesion -Meninges, Neuroepithelium, glioblastoma 2) Metastatic tumors: Often multiple lesions -Lung, melanoma, breast, renal, testicular, GI

Question 61

Neoplasms: 1) ~_____are glial cell origin tumors 2) ~________are meningiomas 3) What makes up the remaining fraction of neoplasms?

Answer 61

1) 1/3 2) 1/3 3) Vestibular schwannomas, pituitary adenoma, neurofibroma, lymphomas

Question 62

The most common CNS tumors in adults are what? (4)

Answer 62

1) Gliomas -of the cerebral hemispheres, particularly glioblastoma - cancerous 2) Menengiomas -most common benign tumor 3) Schwannomas -e.g., acoustic neuroma 4) Primary CNS lymphomas

Question 63

Astrocytoma, ependymoma, and oligodendroglioma have what in common?

Answer 63

All malignant glial cell tumors

Question 64

1) How are astrocytomas graded? 2) Which grade is glioblastoma? How common is glioblastoma?

Answer 64

1) Four grades with worsening prognosis 2) Grade four = glioblastoma; most common primary malignant brain tumor; has poor prognosis.

Question 65

A primary glial cell tumor that occurs in the ependymal cells that line the ventricles and spinal canal is called what?

Answer 65

Ependymoma

Question 66

Metastatic neoplasms: The most common sources of intracranial metastasis in adults are carcinomas from what?

Answer 66

(LaMB) Lung melanoma Breast

Question 67

What are 3 times more common than primary intracranial tumors and have a mostly hematogenous spread?

Answer 67

Metastatic neoplasms from (LaMB) Lung melanoma Breast

Question 68

1) What are some causes of primary neoplasms? 2) What is the origin of most primary neoplasms? 3) What are some other correlations to primary neoplasms?

Answer 68

1) Genetics and exposure to high-dose radiation +FH brain tumors 2) Most are sporadic 3) Toxins and exposures, military history

Question 69

Describe the clinical presentation of CNS neoplasms

Answer 69

**General vs. focal symptoms** 2) **General:** Headache and seizure are secondary to increased intracranial pressure 2) **Focal neurologic symptoms:** unilateral weakness or personality changes due to local destruction/compression

Question 70

Seizure is an example of what kind of Sx of CNS neoplasm?

Answer 70

General

Question 71

1) What are some Sx of secondary increased ICP (from brain tumor)? 2) What are the most common Sx?

Answer 71

1) **Increased intracranial pressure (ICP)** Irritability Lethargy Changes in behavior/personality Gait and balance disorders 2) **Headache, Nausea and vomiting, and seizures**

Question 72

1) What are headaches with brain tumors like? 2) Describe general brain tumor Sx

Answer 72

1) Severe HA, worse in morning, + N/V 2) Chronic, persistent HA with N/V, seizures, change in HA pattern, + neurologic symptoms/signs, or positional worsening should prompt an evaluation for brain tumor (SNNOOPPPP red flags)

Question 73

SNNOOPPPP mnemonic for red flag symptoms in patients with headaches

Answer 73

Systemic symptoms – fever*, rash, myalgia, weight loss, HTN Subdural hematoma, vascular condition Neoplasm – history of cancer Neurologic deficit or dysfunction – focal exam, Sz, MS & cognitive changes Nonvascular IC pathology Onset abrupt (thunderclap HA)* Older patient (> 50 y/o) Painful eye + autonomic symptoms Papilledema* Pathology of immune system Pattern – new HA or change in pattern in usual HA Position exacerbates or relieves HA Pregnancy Posterior fossa, pituitary, cavernous sinus Posttraumatic onset – acute or chronic Precipitating event – sneezing, cough, exercise, sex Progressive and atypical presentation Postpartum Posterior fossa, Arnold-Chiari malformation

Question 74

List some other headache red flag Sx

Answer 74

IC Hypertension, IC condition HIV or opportunistic infection IC pathology IC hypotension or hypertension HTN/pre-eclampsia, epidural HA

Question 75

Thunderclap HA, fever with meningismus, papilledema with focal neuro signs or impaired MS, and acute glaucoma all warrant what?

Answer 75

Emergent evaluation

Question 76

Describe how CNS neoplasms are diagnosed

Answer 76

1) Clinical suspicion 2) Gadolinium enhanced MRI 3) Brain biopsy for pathologic Dx, multispecialty team: Medical oncology, XRT, Surgical 4) Treatment regimen based on tumor type, location, malignant potential, and patients age and physical condition

Question 77

Primary intracranial tumors 1) What is the Tx for gliomas (usually cancer)? 2) What is the Tx for meningiomas? 3) What can help with Sx due to obstructive hydrocephalus? 4) What are some presenting Sx of both of these?

Answer 77

1) Surgical resection with adjuvant chemotherapy 2) Benign, space-occupying - Surgical resection 3) Surgical shunting can provide significant benefits 4) HA n/v, seizures, AMS, focal neuro deficit, cognitive/personality changes

Question 78

Most common primary malignant brain tumor is what?

Answer 78

Astrocytoma/ tumors coming out of the glial/supportive cell tissue

Question 79

1) What is the most common primary malignant brain tumor? 2) Where are these tumors? 3) What is the prognosis and Tx?

Answer 79

1) Glioblastoma; grade 4 (high grade) astrocytoma 2) Coming out of the glial/supportive cell tissue 3) Poor prognosis < 30% survival rate @ 1 year Resection and adjuvant Chemo

Question 80

Meningiomas: 1) What are they? How do they present and who are they more common in? 2) How are they diagnosed? 3) Tx? 4) When do they worsen?

Answer 80

1) Tumors of meninges, usually benign, women > men, ages 40-60, variable presentation depending on location 2) MRI + GAD 3) Surgical resection 4) Worsen with hormone exposure/fluctuations

Question 81

Intracranial and spinal neoplasms: neuroimaging 1) What is preferred? 2) What has a characteristic appearance on MRI that is virtually diagnostic? What do these look like? Where are these typically? 3) What effect can occur?

Answer 81

MRI with gadolinium is preferred 2) Meningiomas: Homogeneous area of increased density, enhances uniformly with contrast -typically coming from meninges 3) Mass effect

Question 82

Schwannoma: 1) Define 2) Where is it usually? 3) Sx? How do you Dx?

Answer 82

1) Benign tumor of Schwann cells which myelinates the neurons -Solitary tumor of peripheral nerves that's usually benign and grow very slowly 2) Usually arise on cranial nerve 8 (acoustic neuroma) causing hearing loss 3) Sx vary greatly depending on location of tumor; Dx is by MRI with contrast agent

Question 83

Primary intracranial tumors: What is the Tx? Describe

Answer 83

Depends on type and site of tumor: 1) Radiation therapy and chemotherapy: long-term cognitive deficits may complicate radiation therapy and chemotherapy 2) Corticosteroids to reduce edema/increased IC pressure, often started prior to other therapy 3) Seizures: phenytoin

Question 84

What are some brain tumor treatments?

Answer 84

1) **Surgical shunting of obstructive hydrocephalus**: dramatically reduce clinical deficits 2) **Radiation and/or chemotherapy:** increase median survival rates in malignant neoplasms, regardless of any preceding surgery 3) **Corticosteroids help to reduce cerebral edema**: usually started before surgery or if symptomatic 4) **Anticonvulsants** are commonly administered in standard doses to prevent seizures 5) Intramedullary cord lesions are treated by decompression and surgical excision and irradiation 6) Treatment of epidural spinal metastases consists of radiation, irrespective of cell type 7) Surgery if solitary, accessible

Question 85

Metastatic intracranial tumors: 1) What is the most common source? 2) Where are most metastatic tumors? 3) When is surgical resection appropriate? 4) What are other Txs?

Answer 85

1) LUNG -Other sources = melanoma, breast (LaMB) 2) Supratentorial 3) If limited number and surgically accessible is standard of therapy for mets 4) Radiation, steroids for swelling, phenytoin for seizures