Flashcards in Tumours of Nervous System Deck (79):
primary brain tumours are the 2nd most common tumour in what kind of patient?
what is the most common cause of cancer death under 40?
brain tumours obvs lol
what are general symptoms of brain tumour?
what name is given to blockage of CSF flow?
what is consequence of raised ICP?
what are symptoms of raised ICP?
what is the characteristics of tumour associated headache?
worse in morning - wakes them up
worse on coughing / leaning forward
associated with vomiting
what determines what neurological signs are present?
what does the frontal lobe control?
higher cognition - thought, reason, intelligence
what does precentral gyrus in frontal lobe control?
what does postcentral gyrus in parietal lobe control?
what does parietal lobe control?
what does temporal lobe control?
memory and emotion
what does the occipital lobe control?
what does cerebellum control?
what investigations could take place for a brain tumour?
which cells of neuroepithelial tissue can form tumours?
ependymal cells / choroid plexus
what % of neuroepithelial tissue tumours are astrocytic?
what % of astrocytic tumours are high grade?
what is a grade I astrocytic tumour?
subependymal giant cell
what is a grade II astrocytic tumour?
low grade astrocytoma
what is a grade III astrocytic tumour?
what is a grade IV astrocytic tumour?
what are the characteristics of a grade I astrocytoma?
who does grade I astrocytomas most commonly occur in?
children and young adults
where in the brain do pilocytic astrocytomas usually occur?
what is treatment for grade I astrocytoma?
surgery - curative
where in the brain do grade II astrocytomas usually occur?
how do those with grade II astrocytomas present?
what are poor prognostic factors for a grade II astrocytoma?
short duration of symptoms
enhancement on contrast
is a grade II astrocytoma benign?
not ultimately since it undergoes differentiation to high grade malignancy (glioblastoma)
what is the treatment of grade II astrocytoma?
surgery +/- radiation, chemo or combined
this depends on molecular profile
what are the two options of brain surgery?
stereotatic vs open
what grades of astrocytomas are malignant?
III and IV
what is the median survival of an anaplastic astrocytoma which can arise de novo?
what is the most common primary brain tumour?
glioblastoma multiforme (grade IV)
what is the median survival of a glioblastoma multiforme?
how does glioblastoma multiforme spread?
white matter tracking / CSF pathways
what could multiple gliomas be a sign of?
progressive multifocal leukoencephalopathy
how are malignant astrocytomas treated?
noncurative surgery - survival quality
post operative radiotherapy - external beam radiation
TMZ - chemo drug
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
when would you give a low grade astrocytoma radiotherapy?
when incomplete removal or malignant degeneration
when would you give a benign astrocytoma radiotherapy?
only if recurrence / progression not amenable to surgery
what are the side effects of radiotherapy?
drops IQ by 10
affects skin and hair
what new novel therapy could be used for astrocytomas?
oligodendroglial tumours make up what % of glial tumours?
what part of the brain do oligodendroglial tumours often occur?
in what age does oligodendroglial tumours usually occur?
smaller peak in children 6-12
how do oligodendroglial tumours often present?
are oligodendroglial tumours mostly low grade or high grade?
with anaplastic / astrocytic component
do oligodendroglial tumours have potential to become malignant?
what are characteristics of oligodendroglial tumours?
calcification (usually peripheral)
how are oligodendroglial tumours treated?
chemosensitive (procarbazine, lomustine, vincristine)
surgery + chemo (surgery for high grade less convincing)
RT + PCV doubles survival
what is the median survival for oligodendroglial tumours?
10 years (for low grade)
what are main symptoms of brain tumours in adults?
headache that wake you +/- vomiting
now neurological deficit, including seizures
what are main symptoms of brain tumours in children?
vomiting with HA
from which cells do meningiomas arise?
arachnoid cap cells
where in the brain do meningiomas occur?
(parasagittal, convexity, sphenoid and intraventricular)
meningiomas make up what % of intracranial neoplasms?
how do meningiomas typically present?
(otherwise - headache, cranial nerve neuropathies and regional anatomical disturbance)
what other conditions are associated with meningiomas?
NF II (22q)
what % of meningiomas are histologically benign?
how can meningiomas be classified?
what can induce a meningioma?
radiation (eg after childhood leukaemia)
what cells are aggressors to meningiomas?
what is seen on CT scan of meningioma?
homogenous, densely enhancing
hyperostosis / skull blistering
what is seen on MRI scan of meningioma?
patency of dural sinuses
what is seen on angiography of meningioma?
external carotid artery feeders
occlusion of sagittal sinus
what is the treatment of meningiomas?
small - expectant
what is the 5 year survival of meningioma?
what is another name of acoustic neuromas?
vestibular schwannomas (of 8th nerve)
how do acoustic neuromas typically present?
what can acoustic neuromas begin to cause problems with as they progress?
5th, 7th and 8th cranial nerves
how are acoustic neuromas treated?
is malignant transformation of acoustic neuroma rare or common?
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
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)
how is hydrocephalus treated?
endoscopic third ventriculostomy (ETV) +/- biopsy (also allows CSF collection)
or VP shunt