Neurological Neoplasms Lecture Powerpoint

Question 1

Primary vs secondary CNS tumors

Answer 1

Primary originate in the tissue of the brain (meninges, glial cells, nerve sheath, etc) vs secondary which is due to metastasis

Question 2

The most common type of primary CNS tumor in children and 2 most common in adults

Answer 2

Glioma, glioma and meningiomas

Question 3

Most CNS tumors in adults are…

Answer 3

….metastatic in origin

Question 4

In adults most CNS tumors are ___ while in children they are ____

Answer 4

Supratentorial, infratentorial

Question 5

Risk factors for CNS tumor development (3)

Answer 5

• Ionizing radiation exposure
• genetics
• trauma or infection

Question 6

Classic presentation raising concern for a CNS tumor (4)

Answer 6

• Seizure
• focal neuro deficits
• cognitive dysfunction
• increased ICP

Question 7

Classic triad of increased intracranial pressure

Answer 7

Headache, nausea, papilledema

Question 8

Rapidly growing tumors cause ___ while slow growing tend to cause ___

Answer 8

headaches, seizures

Question 9

Headache caused by brain tumor accounts for __% of headaches in the general population, how is it typically prescribed?

Answer 9

1%, nonpulsatile bandlike pain around the head (tension type) almost always with other deficits

Question 10

Red flags for headache and CNS lesions that require neuroimaging (6)

Answer 10

• Acute severe headache onset after 50
• headache changed form previous pattern
• headache on exertion, onset at night or early morning, progressive in nature
• new neurologic signs accompanying
• associated with illness
• precipitation with valsalva

Question 11

Imaging study of choice for concern of headache being related to CNS lesion and one alternative

Answer 11

• MRI with contrast

- CT with contrast

Question 12

If a tumor is found on CNS then next step is to…

Answer 12

….screen for systemic malignancy via CT of chest/abdomen/pelvis and then refer to neurosurgery. Metastases may not need biopsy if known primary source

Question 13

3 fundamental treatments for CNS tumors

Answer 13

• surgical resection
• radiotherapy or chemotherapy
• shunting for hydrocephalus

Question 14

Noninvasive symptom treatment for CNS tumor (5)

Answer 14

• glucocorticoids (high dose dexamethasone for severe symptoms unless suspicion for lymphoma)
• analgesics
• Anticonvulsants
• VTE prophylaxis if immobilized (heparin)
• palliative care

Question 15

Astrocytoma

Answer 15

Most common intracranial glioma part of brain itself linked to ionizing radiation and rare genetic syndromes, good prognosis if resected

Question 16

Glioblastoma

Answer 16

Very aggressive type of glioma with necrotic center that has median survival rate of 12-15 months and a high recurrence rate

Question 17

Meningioma

Answer 17

Most common primary brain tumor, often slow growing and some are benign, treated with large surgical resection otherwise radiation and or chemo, sometimes if small watchful waiting

Question 18

Oligodendroma

Answer 18

A type of glioma that is more responsive and has a better prognosis compared to a astrocytoma, treatment is surgical resection and radiation with a median survival >10 years

Question 19

Schwannoma

Answer 19

A nerve sheath tumor that is progressive unilateral hearing loss affecting the vestibule, treated with surgical resection

Question 20

Ependymoma

Answer 20

A type of glioma usually in the spinal canal and curable with surgical resection

Question 21

Medulloblastoma

Answer 21

A embryonal malignant, most common tumor in children that 70% survive but have cognitive impairment, treated by surgical resection, radiation, and chemo

Question 22

CNS Lymphoma

Answer 22

A B cell malignancy that usually occurs in the immunosuppressed and may be a single mass, multiple masses, or meningeal, requires testing for HIV and a PET scan, treated by radiation, chemo, methotrexate

Question 23

Pituitary adenoma

Answer 23

CNS tumor originating from hormone producing cells in pituitary, nearly all are benign but depending on cell type cause different conditions (prolactinoma, acromegaly, and cushing’s disease), treatment is pharmacologic with surgery if needed

Question 24

Most common metastatic lesions to CNS (5)

Answer 24

• lung
• breast
• melanoma
• renal
• GI