Tumours of the Nervous System Flashcards
(44 cards)
Supra/infra tentorial describes tumours above and below what structure in the brain?
Tentorium cerebelli
How do brain tumours usually present?
Neurological deficit
Motor weakness
Headache (due to raised ICP)
Seizures
Most brain tumours are secondary. TRUE/FALSE?
TRUE
Most are metastases
How does hydrocephalus usually present?
sudden raised ICP
=> headache
=> vomiting (due to vomiting centre in thalamus)
=> seizures
An uncal transtentorial herniation presses on which cranial nerve, causing what symptom?
Presses on CN III
=> prevents parasympathetics reaching pupil
=> sympathetics unopposed
=> dilated “Blown out” pupil
What features of a headache would make you suspicious of a raised ICP?
Headaches which wake the patient up
OR if it gets worse when coughing/leaning forward
What other symptoms are usually present with a tumour headache?
- Diplopia (double vision)
- difficulty focussing
- extreme hypertension (cushings triad)
- psychogenic
What behaviours would be affected if the frontal and/or parietal lobes were affected by a tumour?
Thought
Reasoning
Behaviour
Intellect
What would be impaired if the occipital lobe was affected by a tumour?
Speech
Vision
The referral guidelines suggest a referral after presentation of what symptoms?
- behaviour change
- seizure
- headache
- focal neuro deficit
What investigations would be carried out after a referral for a possible neurological tumour?
MRI
Lumbar puncture for CSF markers
Biopsy may be used, but ultimately surgeon may attempt full excision
Is papilloedema a late or early sign of raised ICP?
LATE
<10% have this on presentation with increased ICP
What general symptoms should be checked if suspicion of brain metastases is high?
- unintentional weight loss
- haemoptysis/haematuria
- evidence of melanoma on skin
- check axillae for freckling => neurofibromatosis Type 1
- check toenails for subungual keratomas => tuberous sclerosis
What are the 4 grades of nervous system tumours set out by the WHO?
I - benign
II - pre-malignant (can change over years)
III - malignant
IV - aggressively malignant
Where and in what what patient groups are Grade 1 astocytomas normally found?
Cerebellar/ brainstem tumours
found in children and young adults
How quickly do grade 1 astrocytomas grow, and how are they treated?
Grow slowly (benign) Tx: surgical excision
Grade 1 astrocytomas take up contrast on CT. TRUE/FALSE?
TRUE
Look like meningiomas on CT
Where do low grade astrocytomas (Grade II) present and what symptoms are usually experienced?
Temporal lobe
Anterior parietal/posterior frontal lobes
- present with seizures
DO grade II astrocytomas take up contrast?
No
Look well circumscribed BUT difficult to see exact margins
Grade II astrocytomas can progress to grade III or IV. TRUE/FALSE?
TRUE
What indicates a poor prognosis?
> 50 years old
- focal deficit
- short symptom duration
- raised ICP
- altered conciousness
- enhances with contrast (both grade III and IV do this)
When would it be unsafe to excise a tumour?
If it is in an area of the pons/brainstem where removal would cause significant damage
What genetic co-deletion increases chance of survival post-resection?
IDH-1 1p19q co-deletion
Radiotherapy and chemotherapy in combination after surgery have imporved life expectancy. TRUE/FALSE?
TRUE
