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Neurology > Tumours of Nervous System > Flashcards

Tumours of Nervous System Flashcards

1
Q

primary brain tumours are the 2nd most common tumour in what kind of patient?

A

children

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2
Q

what is the most common cause of cancer death under 40?

A

brain tumours obvs lol

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3
Q

what are general symptoms of brain tumour?

A

neurological deficit
motor weakness
headache
seizures

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4
Q

what name is given to blockage of CSF flow?

A

hydrocephalus

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5
Q

what is consequence of raised ICP?

A

haemorrhage

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6
Q

what are symptoms of raised ICP?

A

headaches
vomiting
mental changes
seizures

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7
Q

what is the characteristics of tumour associated headache?

A

worse in morning - wakes them up

worse on coughing / leaning forward

associated with vomiting

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8
Q

what determines what neurological signs are present?

A

tumour relocation

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9
Q

what does the frontal lobe control?

A

motor

higher cognition - thought, reason, intelligence

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10
Q

what does precentral gyrus in frontal lobe control?

A

movement

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11
Q

what does postcentral gyrus in parietal lobe control?

A

sensation

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12
Q

what does parietal lobe control?

A

sensory

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13
Q

what does temporal lobe control?

A

language
hearing
memory and emotion
association

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14
Q

what does the occipital lobe control?

A

vision

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15
Q

what does cerebellum control?

A

balance

co-ordination

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16
Q

what investigations could take place for a brain tumour?

A 
CT
MRI
LP
PET
lesion biopsy 
EEG
evoked potentials
angiograms 
radionucleotide studies
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17
Q

which cells of neuroepithelial tissue can form tumours?

A 
astrocytes 
oligodendroglial cells 
ependymal cells / choroid plexus 
neuronal cells 
pineal cells 
embryonic
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18
Q

what % of neuroepithelial tissue tumours are astrocytic?

A

60%

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19
Q

what % of astrocytic tumours are high grade?

A

33%

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20
Q

what is a grade I astrocytic tumour?

A

pilocytic astrocytoma
pleomorphic xanthoastrocytoma
subependymal giant cell

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21
Q

what is a grade II astrocytic tumour?

A

low grade astrocytoma

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22
Q

what is a grade III astrocytic tumour?

A

anaplastic astrocytoma

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23
Q

what is a grade IV astrocytic tumour?

A

glioblastoma multiforme

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24
Q

what are the characteristics of a grade I astrocytoma?

A

truly benign

slow growing

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25
who does grade I astrocytomas most commonly occur in?
children and young adults
26
where in the brain do pilocytic astrocytomas usually occur?
optic nerve hypothalamic gliomas cerebellum brainstem
27
what is treatment for grade I astrocytoma?
surgery - curative
28
where in the brain do grade II astrocytomas usually occur?
temporal lobe posterior frontal anterior parietal
29
how do those with grade II astrocytomas present?
seizures
30
what are poor prognostic factors for a grade II astrocytoma?
``` age >50 focal deficit short duration of symptoms raised ICP altered consciousness enhancement on contrast ```
31
is a grade II astrocytoma benign?
not ultimately since it undergoes differentiation to high grade malignancy (glioblastoma)
32
what is the treatment of grade II astrocytoma?
surgery +/- radiation, chemo or combined this depends on molecular profile
33
what are the two options of brain surgery?
stereotatic vs open
34
what grades of astrocytomas are malignant?
III and IV
35
what is the median survival of an anaplastic astrocytoma which can arise de novo?
2 years
36
what is the most common primary brain tumour?
glioblastoma multiforme (grade IV)
37
what is the median survival of a glioblastoma multiforme?
<1 year
38
how does glioblastoma multiforme spread?
white matter tracking / CSF pathways
39
what could multiple gliomas be a sign of?
neurofibromatosis tuberous sclerosis progressive multifocal leukoencephalopathy
40
how are malignant astrocytomas treated?
noncurative surgery - survival quality post operative radiotherapy - external beam radiation TMZ - chemo drug
41
in what circumstances, is it not safe to drive after brain surgery?
if seizure risk (all GBM) or if left with significant homonymous visual field defect
42
when would you give a low grade astrocytoma radiotherapy?
when incomplete removal or malignant degeneration
43
when would you give a benign astrocytoma radiotherapy?
only if recurrence / progression not amenable to surgery
44
what are the side effects of radiotherapy?
drops IQ by 10 affects skin and hair tired
45
what new novel therapy could be used for astrocytomas?
immunotherapy
46
oligodendroglial tumours make up what % of glial tumours?
20
47
what part of the brain do oligodendroglial tumours often occur?
frontal lobes
48
in what age does oligodendroglial tumours usually occur?
adults 25-45yrs smaller peak in children 6-12
49
how do oligodendroglial tumours often present?
seizures
50
are oligodendroglial tumours mostly low grade or high grade?
low grade with anaplastic / astrocytic component
51
do oligodendroglial tumours have potential to become malignant?
yes
52
what are characteristics of oligodendroglial tumours?
calcification (usually peripheral) cysts peritumoral haemorrhage
53
how are oligodendroglial tumours treated?
chemosensitive (procarbazine, lomustine, vincristine) surgery + chemo (surgery for high grade less convincing) RT + PCV doubles survival
54
what is the median survival for oligodendroglial tumours?
10 years (for low grade)
55
what are main symptoms of brain tumours in adults?
headache that wake you +/- vomiting now neurological deficit, including seizures
56
what are main symptoms of brain tumours in children?
tiptoeing ataxia vomiting with HA
57
from which cells do meningiomas arise?
arachnoid cap cells
58
where in the brain do meningiomas occur?
extra axial | parasagittal, convexity, sphenoid and intraventricular
59
meningiomas make up what % of intracranial neoplasms?
20
60
how do meningiomas typically present?
asymptomatic | otherwise - headache, cranial nerve neuropathies and regional anatomical disturbance
61
what other conditions are associated with meningiomas?
``` breast cancer NF II (22q) ```
62
what % of meningiomas are histologically benign?
90%
63
how can meningiomas be classified?
classic angioblastic atypical (2%) malignant (5%)
64
what can induce a meningioma?
radiation (eg after childhood leukaemia)
65
what cells are aggressors to meningiomas?
clear cell choroid rhabdoid papillary
66
what is seen on CT scan of meningioma?
homogenous, densely enhancing oedema hyperostosis / skull blistering
67
what is seen on MRI scan of meningioma?
dural tail | patency of dural sinuses
68
what is seen on angiography of meningioma?
external carotid artery feeders | occlusion of sagittal sinus
69
what is the treatment of meningiomas?
small - expectant preoperative embolisation surgery radiotherapy
70
what is the 5 year survival of meningioma?
90%
71
what is another name of acoustic neuromas?
vestibular schwannomas (of 8th nerve)
72
how do acoustic neuromas typically present?
hearing loss tinnitus dysequilibrium
73
what can acoustic neuromas begin to cause problems with as they progress?
5th, 7th and 8th cranial nerves brainstem function hydrocephalus
74
how are acoustic neuromas treated?
expectant hydrocephalus management radiation surgery
75
is malignant transformation of acoustic neuroma rare or common?
rare
76
how are hearing and balance affected after acoustic neuroma surgery?
hearing - decline over several years vestibular function - worsen substantially in first 6 months and remain stable thereafter
77
what tumour markers must be performed for any midline brain tumour in a child?
AFP (yolk sac tumours and teratomas) beta HCG (choriocarcinoma and germinoma) LDH (germaninoma and choriocarcinoma and yolk sac)
78
how is hydrocephalus treated?
endoscopic third ventriculostomy (ETV) +/- biopsy (also allows CSF collection) or VP shunt
79
what must you remember and do if patient has HA, vomiting and ataxia?
fundoscopy

Neurology (32 decks)

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