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Flashcards in Tumours of Nervous System Deck (79):
1

primary brain tumours are the 2nd most common tumour in what kind of patient?

children

2

what is the most common cause of cancer death under 40?

brain tumours obvs lol

3

what are general symptoms of brain tumour?

neurological deficit
motor weakness
headache
seizures

4

what name is given to blockage of CSF flow?

hydrocephalus

5

what is consequence of raised ICP?

haemorrhage

6

what are symptoms of raised ICP?

headaches
vomiting
mental changes
seizures

7

what is the characteristics of tumour associated headache?

worse in morning - wakes them up

worse on coughing / leaning forward

associated with vomiting

8

what determines what neurological signs are present?

tumour relocation

9

what does the frontal lobe control?

motor

higher cognition - thought, reason, intelligence

10

what does precentral gyrus in frontal lobe control?

movement

11

what does postcentral gyrus in parietal lobe control?

sensation

12

what does parietal lobe control?

sensory

13

what does temporal lobe control?

language
hearing
memory and emotion
association

14

what does the occipital lobe control?

vision

15

what does cerebellum control?

balance
co-ordination

16

what investigations could take place for a brain tumour?

CT
MRI
LP
PET
lesion biopsy
EEG
evoked potentials
angiograms
radionucleotide studies

17

which cells of neuroepithelial tissue can form tumours?

astrocytes
oligodendroglial cells
ependymal cells / choroid plexus
neuronal cells
pineal cells
embryonic

18

what % of neuroepithelial tissue tumours are astrocytic?

60%

19

what % of astrocytic tumours are high grade?

33%

20

what is a grade I astrocytic tumour?

pilocytic astrocytoma
pleomorphic xanthoastrocytoma
subependymal giant cell

21

what is a grade II astrocytic tumour?

low grade astrocytoma

22

what is a grade III astrocytic tumour?

anaplastic astrocytoma

23

what is a grade IV astrocytic tumour?

glioblastoma multiforme

24

what are the characteristics of a grade I astrocytoma?

truly benign
slow growing

25

who does grade I astrocytomas most commonly occur in?

children and young adults

26

where in the brain do pilocytic astrocytomas usually occur?

optic nerve
hypothalamic gliomas
cerebellum
brainstem

27

what is treatment for grade I astrocytoma?

surgery - curative

28

where in the brain do grade II astrocytomas usually occur?

temporal lobe
posterior frontal
anterior parietal

29

how do those with grade II astrocytomas present?

seizures

30

what are poor prognostic factors for a grade II astrocytoma?

age >50
focal deficit
short duration of symptoms
raised ICP
altered consciousness
enhancement on contrast

31

is a grade II astrocytoma benign?

not ultimately since it undergoes differentiation to high grade malignancy (glioblastoma)

32

what is the treatment of grade II astrocytoma?

surgery +/- radiation, chemo or combined

this depends on molecular profile

33

what are the two options of brain surgery?

stereotatic vs open

34

what grades of astrocytomas are malignant?

III and IV

35

what is the median survival of an anaplastic astrocytoma which can arise de novo?

2 years

36

what is the most common primary brain tumour?

glioblastoma multiforme (grade IV)

37

what is the median survival of a glioblastoma multiforme?

<1 year

38

how does glioblastoma multiforme spread?

white matter tracking / CSF pathways

39

what could multiple gliomas be a sign of?

neurofibromatosis

tuberous sclerosis

progressive multifocal leukoencephalopathy

40

how are malignant astrocytomas treated?

noncurative surgery - survival quality

post operative radiotherapy - external beam radiation

TMZ - chemo drug

41

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

42

when would you give a low grade astrocytoma radiotherapy?

when incomplete removal or malignant degeneration

43

when would you give a benign astrocytoma radiotherapy?

only if recurrence / progression not amenable to surgery

44

what are the side effects of radiotherapy?

drops IQ by 10
affects skin and hair
tired

45

what new novel therapy could be used for astrocytomas?

immunotherapy

46

oligodendroglial tumours make up what % of glial tumours?

20

47

what part of the brain do oligodendroglial tumours often occur?

frontal lobes

48

in what age does oligodendroglial tumours usually occur?

adults 25-45yrs

smaller peak in children 6-12

49

how do oligodendroglial tumours often present?

seizures

50

are oligodendroglial tumours mostly low grade or high grade?

low grade

with anaplastic / astrocytic component

51

do oligodendroglial tumours have potential to become malignant?

yes

52

what are characteristics of oligodendroglial tumours?

calcification (usually peripheral)
cysts
peritumoral haemorrhage

53

how are oligodendroglial tumours treated?

chemosensitive (procarbazine, lomustine, vincristine)

surgery + chemo (surgery for high grade less convincing)

RT + PCV doubles survival

54

what is the median survival for oligodendroglial tumours?

10 years (for low grade)

55

what are main symptoms of brain tumours in adults?

headache that wake you +/- vomiting

now neurological deficit, including seizures

56

what are main symptoms of brain tumours in children?

tiptoeing
ataxia
vomiting with HA

57

from which cells do meningiomas arise?

arachnoid cap cells

58

where in the brain do meningiomas occur?

extra axial

(parasagittal, convexity, sphenoid and intraventricular)

59

meningiomas make up what % of intracranial neoplasms?

20

60

how do meningiomas typically present?

asymptomatic

(otherwise - headache, cranial nerve neuropathies and regional anatomical disturbance)

61

what other conditions are associated with meningiomas?

breast cancer
NF II (22q)

62

what % of meningiomas are histologically benign?

90%

63

how can meningiomas be classified?

classic
angioblastic
atypical (2%)
malignant (5%)

64

what can induce a meningioma?

radiation (eg after childhood leukaemia)

65

what cells are aggressors to meningiomas?

clear cell
choroid
rhabdoid
papillary

66

what is seen on CT scan of meningioma?

homogenous, densely enhancing
oedema
hyperostosis / skull blistering

67

what is seen on MRI scan of meningioma?

dural tail
patency of dural sinuses

68

what is seen on angiography of meningioma?

external carotid artery feeders
occlusion of sagittal sinus

69

what is the treatment of meningiomas?

small - expectant
preoperative embolisation
surgery
radiotherapy

70

what is the 5 year survival of meningioma?

90%

71

what is another name of acoustic neuromas?

vestibular schwannomas (of 8th nerve)

72

how do acoustic neuromas typically present?

hearing loss
tinnitus
dysequilibrium

73

what can acoustic neuromas begin to cause problems with as they progress?

5th, 7th and 8th cranial nerves

brainstem function

hydrocephalus

74

how are acoustic neuromas treated?

expectant
hydrocephalus management
radiation
surgery

75

is malignant transformation of acoustic neuroma rare or common?

rare

76

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

77

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)

78

how is hydrocephalus treated?

endoscopic third ventriculostomy (ETV) +/- biopsy (also allows CSF collection)

or VP shunt

79

what must you remember and do if patient has HA, vomiting and ataxia?

fundoscopy