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Neurology > Brain tumours > Flashcards

Flashcards in Brain tumours Deck (62):
1

What is a brain tumour?

Growth of cells
Benign or malignant
Primary or secondary
Supra or infratentorial
Extrinsic or intrinsic

2

What are common presentations for brain tumours?

Progressive neurological deficit
Motor weakness
Headache - raised ICP
Seizures

3

What can result in an increased ICP?

Contribution of mass within a rigid closed box
Tumour/ mass/ oedema mass effect
Hydrocephalus
Haemorrhage

4

What are symptoms of increased ICP?

Headaches
Vomiting
Mental changes
Seizures

5

What are different types of herniation?

Coning; tonsillar herniation
Uncal herniation
Subfalcine

6

What is cushing's reflex?

Hypertension
Bradycardia
Respiratory depression

7

What occurs with an uncal herniation?

Ipsilateral blown pupil as the herniation presses on the 3rd CN (can also get down and out pupil)

8

What is a bad sign with headaches?

If it wakes you up in the morning or worse in the morning

9

What should be done immediately with a headache worse in the morning?

FUNDOSCOPY to look for papilloedema

10

Why will increased ICP result in vomiting?

Increased pressure on the medulla

11

Will a headache associated with increased ICP get better or worse on coughing and leaning forward?

Worse

12

What should be given immediately if cushing's triad is present?

Mannitol

13

Where should you look if there are metastases in the brain?

Testes
Breasts
Melanoma (moles, subungal)
Axillary freckling for NF1

14

What are tumours of the neuroepithelial tissue?

Astrocytes
Oligodendroglial cells
Ependymal cells/ choroid plexus
Neuronal
Pineal
Embryonic - AFP, LDH, b-hcg

15

What is a grade 1 astrocytic tumour?

Pilocytic
Pleomorphic xanthoastroytoma
Subependymal glial cell

16

What is a grade 2 astrocytoma?

Low grade

17

What is a grade 3 astrocytoma?

Anaplastic astrocytoma

18

What is a grade 4 astrocytoma?

Glioblastoma multiforme

19

Describe a grade 1 astrocytoma

Benign
Slow growing
Children and young adults
Cerebellum affected

20

How are grade 1 astrocytomas treated?

Surgery

21

What are poor prognostic factors associated with low grade astrocytomas?

Age over 50
Focal deficit
Short duration of symptoms
Raised ICP
Altered consciousness
Enhancement on contrast studies

22

What is the treatment of a grade 2 astrocytoma?

Surgery +/- radio and chemo

23

What will low grade astrocytomas commonly present with?

Seizures

24

What is the median survival for an anaplastic astrocytoma?

2 years

25

What is the median survival for a glioblastoma multiforme?

14 months

26

Where will a GBM spread?

White matter tracking through corpus callosum and corticospinal tracts

27

What should you think about if there are multiple gliomas?

NF
Tuberous sclerosis
PML (Progressive multifocal leukoencephalopathy)

28

What is the treatment for GBM?

Non curative surgery to reduce mass effect
Post-op radiotherapy
If MGMT promoter myelination; should get treatment with oral alkylating chemotherapy

29

What will a GBM look like on MRI?

Heterogeneously enhancing SOL with areas of necrosis and a butterfly appearance

30

What is the grading of gliomas based off?

Cellular and nuclear atypia
Mitotic activity
Vascular endothelial proliferation
Necrosis

31

What do pilocytic astrocytomas look like pathologically?

Bipolar cells with long hair like projections

32

What are common sites for pilocytic astrocytomas?

Cerebellum
Midline; thalamus or optic chiasm

33

Where will oligodendrocytes grow?

Frontal lobe of cerebral hemisphere and can affect white matter and cortex

34

From what cell type will meningiomas grow?

Arachnoid cap cells in the arachnoid membrane

35

What is Foster Kennedy Syndrome?

Optic atrophy in ipsilateral eye and papilloedema int he contralateral eye

36

What are the common presentations of meningiomas?

Headache
Increased ICP

37

What are the clinical features of a prolactinoma?

Amenorrhoea
Infertility
Galactorrhoea
Loss of libido
ED

38

How are prolactinomas treated?

Dopamine agonist; cabergoline
Basically never operated on

39

What are the clinical symptoms of a growth hormone secreting tumour?

Pre-puberty: gigantism
Post-puberty: acromegaly

40

What tests should be run in the diagnosis of acromegaly?

Growth hormone levels
IGF-1 levels
OGTT

41

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)

42

How are pituitary tumours operated on?

Transsphenoidal hypophysectomy

43

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

44

What is the treatment of pituitary tumours if they are too large or are invading the cavernous sinus?

Radiotherapy

45

What is a vestibular schwannoma?

Benign tumours of schwann cells at the cerebellopontine angle affect the vestibular portion of CN8

46

What are the symptoms of a vestibular schwannoma?

Unilateral:
Tinnitus
Vertigo
+/- headache
+/- facial numbness

47

What does a bilateral vestibular schwannoma indicate?

NF2

48

What do vestibular schwannomas look like histologically?

Verocay bodies which are palisading nuclei against a fibrillary background

49

What is a haemangioblastoma?

Benign, cystic, highly vascular tumour

50

Where do haemangioblastomas originate?

Posterior fossa - resulting in cerebellar dysfunction and increased ICP

51

What conditions are haemangioblastomas associated with?

VHL:
Haemangioblastoma
Retinal angioma
Renal cell carcinoma
Phaeo

52

Describe an upper motor neurone lesion

Hypertonia
Hyperreflexia
Spasticity
+ve babinski sign
Clonus

53

Describe a lower motor neurone lesion

Hyporeflexia
Hypotonia
Flaccid muscle weakness
Fasciculations
Muscle atrophy

54

How will children commonly present with brain tumours?

Tiptoeing
Ataxia
Vomiting with headache

55

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

56

What are the signs of a vestibular schwannoma?

Facial nerve palsy
Corneal reflex absent
Nystagmus
Hydrocephalus

57

What should be performed in any child with a midline tumour?

AFP
Beta-hcg
LDH
But not in increased ICP (risk of herniation)

58

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
Seizures

59

What are the symptoms of a temporal lobe tumour/ stroke/ lesion?

Memory deficit
Receptive aphasia if wernickes
Contralateral superior quadrantanopia
Seizures

60

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

61

What are the symptoms of an occipital lobe tumour/ stroke/ lesion?

Contralateral homonymous hemianopia
Visual hallucinations

62

What are the symptoms of a cerebellar tumour/ stroke/ lesion?

Ipsilateral ataxia
N+V
Dizziness and vertigo
Slurred speech
Intention tremor