Flashcards in Brain tumours Deck (62):
What is a brain tumour?
Growth of cells
Benign or malignant
Primary or secondary
Supra or infratentorial
Extrinsic or intrinsic
What are common presentations for brain tumours?
Progressive neurological deficit
Headache - raised ICP
What can result in an increased ICP?
Contribution of mass within a rigid closed box
Tumour/ mass/ oedema mass effect
What are symptoms of increased ICP?
What are different types of herniation?
Coning; tonsillar herniation
What is cushing's reflex?
What occurs with an uncal herniation?
Ipsilateral blown pupil as the herniation presses on the 3rd CN (can also get down and out pupil)
What is a bad sign with headaches?
If it wakes you up in the morning or worse in the morning
What should be done immediately with a headache worse in the morning?
FUNDOSCOPY to look for papilloedema
Why will increased ICP result in vomiting?
Increased pressure on the medulla
Will a headache associated with increased ICP get better or worse on coughing and leaning forward?
What should be given immediately if cushing's triad is present?
Where should you look if there are metastases in the brain?
Melanoma (moles, subungal)
Axillary freckling for NF1
What are tumours of the neuroepithelial tissue?
Ependymal cells/ choroid plexus
Embryonic - AFP, LDH, b-hcg
What is a grade 1 astrocytic tumour?
Subependymal glial cell
What is a grade 2 astrocytoma?
What is a grade 3 astrocytoma?
What is a grade 4 astrocytoma?
Describe a grade 1 astrocytoma
Children and young adults
How are grade 1 astrocytomas treated?
What are poor prognostic factors associated with low grade astrocytomas?
Age over 50
Short duration of symptoms
Enhancement on contrast studies
What is the treatment of a grade 2 astrocytoma?
Surgery +/- radio and chemo
What will low grade astrocytomas commonly present with?
What is the median survival for an anaplastic astrocytoma?
What is the median survival for a glioblastoma multiforme?
Where will a GBM spread?
White matter tracking through corpus callosum and corticospinal tracts
What should you think about if there are multiple gliomas?
PML (Progressive multifocal leukoencephalopathy)
What is the treatment for GBM?
Non curative surgery to reduce mass effect
If MGMT promoter myelination; should get treatment with oral alkylating chemotherapy
What will a GBM look like on MRI?
Heterogeneously enhancing SOL with areas of necrosis and a butterfly appearance
What is the grading of gliomas based off?
Cellular and nuclear atypia
Vascular endothelial proliferation
What do pilocytic astrocytomas look like pathologically?
Bipolar cells with long hair like projections
What are common sites for pilocytic astrocytomas?
Midline; thalamus or optic chiasm
Where will oligodendrocytes grow?
Frontal lobe of cerebral hemisphere and can affect white matter and cortex
From what cell type will meningiomas grow?
Arachnoid cap cells in the arachnoid membrane
What is Foster Kennedy Syndrome?
Optic atrophy in ipsilateral eye and papilloedema int he contralateral eye
What are the common presentations of meningiomas?
What are the clinical features of a prolactinoma?
Loss of libido
How are prolactinomas treated?
Dopamine agonist; cabergoline
Basically never operated on
What are the clinical symptoms of a growth hormone secreting tumour?
What tests should be run in the diagnosis of acromegaly?
Growth hormone levels
What tests should be run to diagnose cushing's disease?
Low dose dexamethasone test to confirm cortisol excess
High dose dexamethasone test to differentiate between adrenal or pituitary causes (high dose will suppress cortisol if the source is pituitary)
How are pituitary tumours operated on?
What is the medical management of a growth hormone secreting tumour?
Pegvisomant and a somatostatin analogue such as octreotide to shrink the tumour pre surgery
What is the treatment of pituitary tumours if they are too large or are invading the cavernous sinus?
What is a vestibular schwannoma?
Benign tumours of schwann cells at the cerebellopontine angle affect the vestibular portion of CN8
What are the symptoms of a vestibular schwannoma?
+/- facial numbness
What does a bilateral vestibular schwannoma indicate?
What do vestibular schwannomas look like histologically?
Verocay bodies which are palisading nuclei against a fibrillary background
What is a haemangioblastoma?
Benign, cystic, highly vascular tumour
Where do haemangioblastomas originate?
Posterior fossa - resulting in cerebellar dysfunction and increased ICP
What conditions are haemangioblastomas associated with?
Renal cell carcinoma
Describe an upper motor neurone lesion
+ve babinski sign
Describe a lower motor neurone lesion
Flaccid muscle weakness
How will children commonly present with brain tumours?
Vomiting with headache
What occurring in childhood will increase the risk of developing a meningioma as an adult?
Radiotherapy e.g. child with leukaemia
Meningioma will typically present with midline shift in the frontal lobe
What are the signs of a vestibular schwannoma?
Facial nerve palsy
Corneal reflex absent
What should be performed in any child with a midline tumour?
But not in increased ICP (risk of herniation)
What are symptoms of frontal lobe tumours/stroke/lesions?
Contralateral weakness due to deficit in primary motor cortex
Personality changes including disinhibition and cognitive slowing
Urinary incontinence due to disruption of micturition inhibition centre
Gaze abnormalities if involvement of frontal eye fields
Expressive dysphasia if brocas involved
What are the symptoms of a temporal lobe tumour/ stroke/ lesion?
Receptive aphasia if wernickes
Contralateral superior quadrantanopia
What are the symptoms of a parietal lobe tumour/ stroke/ lesion?
Contralateral weakness and sensory loss
Contralateral inferior quadrantanopia
Dyscalculia - difficulty with maths
Dysgraphia- difficulty in ability to write
Finger agnosia - inability to distinguish fingers
Left-right disorientation- confusion between right and left limbs
If dominant lobe affected; gerstmann syndrome
If non-dominant lobe affected; neglect, dressing apraxia and constructional apraxia
What are the symptoms of an occipital lobe tumour/ stroke/ lesion?
Contralateral homonymous hemianopia