Brain Tumours

Question 1

What are examples of CNS tumours?

Answer 1

• Tumours of neuroepitheal tissue
• Tumours of meninges
• Tumours of cranial and spinal nerves
• Haematopoitic neoplasms
• Germ cell tumours
• Cysts and tumour like lesions
• Tumours of the sellar region
• Local extensions from regional tumours
• Metastatic tumours

Question 2

What are some common primary brain tumours?

Answer 2

Question 3

What are some common secondary brain tumours?

Answer 3

Renal cell carcnoma

Lung carcinoma

Breast carcinoma

Malignant melanoma

GI tract

Question 4

What is the most common brain tumour seen clinically?

Answer 4

Metastases

Question 5

What are gliomas?

Answer 5

Cancer of astrocytes

Question 6

What is the function of astrocytes?

Answer 6

Astrocytes give structural and nutritional support to nerve cells

Question 7

How are gliomas staged?

Answer 7

WHO grades from I to IV, with IV being the most common:

• Most aggressive
• Glioblastoma multiforme (GBM)
• Spread by tracking through white mater and CSF pathway
• Very rarely spread systematically

Question 8

What are meningiomas?

Answer 8

Cancer of meninges

Question 9

What are the characteristics of meningiomas?

Answer 9

• Slow growing
• Extra-axial
• Usually benign
• Arise from arachnoid
• Frequently occur along falx, convexity or sphenoid bone
• Usually cured if completely removed

Question 10

Are meningiomas slow or fast growing?

Answer 10

Slow growing

Question 11

Are meningiomas usually benign or malignant?

Answer 11

Benign

Question 12

What do meningiomas arise from?

Answer 12

Arachnoid tissue

Question 13

What is the most common pituitary tumour?

Answer 13

Adenoma

Question 14

Are pituitary tumours usually benign or malignant?

Answer 14

Benign, only 1% are malignant

Question 15

What is the clinical presentation of pituitary tumours?

Answer 15

• Visual disturbance
  
  • Due to compression of optic chiasm
• Hormone imbalance
• Raised ICP
  
  • Mass effect
• Focal neurological deficit
• Epileptic fits
• CSF obstruction

Question 16

What are symptoms of raised ICP?

Answer 16

• Headache
  
  • Typically morning headache
• Nausea/vomiting
• Visual disturbance
  
  • Diplopia
• Somnolence
• Cognitive impairment
• Altered consciousness

Question 17

When does the headache due to raised ICP usually occur?

Answer 17

Morning

Question 18

What are signs of raised ICP?

Answer 18

• Papilleodema
• 6^th nerve palsy
• Cognitive impairment
• Altered consciousness
• 3^rd nerve palsy

Question 19

What is the typical CSF production in a day?

Answer 19

400-450cc

Question 20

What is hydrocephalus caused by?

Answer 20

Caused by tumours in or close to CSF pathways, especially posterior fossa tumours (pituitary)

Question 21

What is done to diagnose hydrocephalus?

Answer 21

• History and examination
• Think sources of secondary tumours (such as chest x-ray)
• CT scan
• MRI scan
• Biopsy

Question 22

What is focal neurological deficit?

Answer 22

Problem with nerve, spinal cord, or brain function, affecting a specific location such as part of tongue or side of face

Question 23

What is the clinical presentation of focal neurological deficit?

Answer 23

• Hemiparesis
• Dysphagia
• Hemianopia
• Cognitive impairment (memory, sense of direction)
• Cranial nerve palsy
• Endocrine disorders

Question 24

What is hemianopia?

Answer 24

Blindness over half the field of vision

Question 25

What is ataxia?

Answer 25

Term for group of disorders that affect co-ordination, balance and speech

Question 26

What does in-coordination mean?

Answer 26

Harmonious functioning of parts for effective results

Question 27

What is the medical term for loss of ability to perform simple calculations?

Answer 27

Acalculia

Question 28

What is the medical term for loss of ability to communicate through writing?

Answer 28

Agraphia

Question 29

What is the medical term for inability to interpret sensations and hence recognise things?

Answer 29

Agosia

Question 30

What are the 2 kinds of epilepsy?

Answer 30

* Focal epilepsy * Generalised epilepsy

Question 31

Epilepsy only occurs in lesions above where\>?

Answer 31

Tentorium

Question 32

What investigations are done for brain tumours?

Answer 32

Adequate cerebral imaging: * CT * MRI * PET * Angiography If suspected metastases: * CT chest/abdomen/pelvis * Mammography * Biopsy skin lesions/lymph nodes

Question 33

What are the managent goals for a brain tumour?

Answer 33

* Accurate tissue diagnosis * Improve quality of life * Decreasing mass effect * Improve neurological deficit * Aid effect of adjuvant therapy * Prolong life expectancy

Question 34

What does the management of a brain tumour involve?

Answer 34

* Corticosteroids * Dexamethasone * Treat epilepsy * Anticonvulsant drugs * Analgesics/antimetics * Counselling * Surgery * Radiotherapy * Chemotherapy * Endocrine replacement

Question 35

What are the management options for a brain tumour?

Answer 35

Question 36

What is the prognosis of meningioma?

Answer 36

* Commonly cured by surgery, may required anticonvulsants

Question 37

What is the prognosis of low grade astrocytomas?

Answer 37

Long life expectancy

Question 38

What is the prognosis of high grade astrocytoma/GBM?

Answer 38

Average 1 year survival

Question 39

What is the prognosis of metastases in the brain?

Answer 39

* Frequently good medium term remission

Question 40

When should a LP never be performed?

Answer 40

Remember, DO NOT perform a lumbar puncture when there are signs and symptoms to suggest an intracranial mass lesion, this is because you might: * Cause meningitis * Cause a herniation syndrome and the patient could die * Cause an air embolism * Make the patient’s headache worse

Question 41

Why should a lumbar puncture never be performed when there are signs/symptoms to suggest an intracranial mass lesion?

Answer 41

Because you might: * Cause meningitis * Cause a herniation syndrome and the patient could die * Cause an air embolism * Make the patient’s headache worse