BMB 2 - CNS Neoplasms; Paraneoplastic & Autoimmune Encephalitis Flashcards Preview

T2 - Phase 3 - Brain, Mind, and Behavior > BMB 2 - CNS Neoplasms; Paraneoplastic & Autoimmune Encephalitis > Flashcards

Flashcards in BMB 2 - CNS Neoplasms; Paraneoplastic & Autoimmune Encephalitis Deck (49)
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1
Q

Metastatic malignancies to the brain are ____x more likely than primary malignancies.

A

Metastatic malignancies to the brain are 10 x more likely than primary malignancies.

2
Q

20% of metastases to the adult brain come from what organ system?

A

The lungs

3
Q

What are the four most common origin sites for metastases ending up in the adult brain?

A

Lung > melanoma > breast > renal cell carcinomas

(>> colorectal)

4
Q

What are the three most common origin sites for metastases ending up in the pediatric brain?

A

Sarcomas

Neuroblastomas

Germ cell tumors

5
Q

What are the most common origin sites for hemorrhagic metastases ending up in the adult brain?

A

Melanoma,

renal,

thyroid,

choriocarcinoma

6
Q

What is the most common type of primary brain cancer?

A

Diffusely infiltrating gliomas

(e.g. glioblastoma multiforme)

7
Q

Name some of the various S/Sy sometimes seen in patients with primary brain tumors?

A

Weakness and numbness

Aphasia

Seizures

Ataxia and gait impairment

Headaches

Brainstem symptoms

Blindness

8
Q

Primary brain tumors are generally more associated with epilepsy in ________er patient populations and due to the less common, _______-grade gliomas.

A

Primary brain tumors are generally more associated with epilepsy in younger patient populations and due to the less common, high-grade gliomas.

9
Q

Why are high-grade gliomas more likely to result in epilepsy than low-grade?

A

Due to an IDH 1/2 mutation which results in production of 2-hydroxyglutarate, which is both cytotoxic and stimulatory

(i.e. they produce glutamate, which is excitatory)

10
Q

Brain metastases do not typically cause seizures; they are only more likely to cause them in what circumstances?

A

Unless (1) the cortex is involved or (2) the metastases are hemorrhagic

11
Q

Brain metastases are widely associated with _________ edema and ____toxicity.

A

Brain metastases are widely associated with vasogenic edema and cytotoxicity.

12
Q

True/False.

MRI is the main imaging technique used in identifying brain metastases.

A

True.

13
Q

How do brain metastases typically present on MRI?

A

Multiple, well-circumscribed lesions at the gray-white junction

14
Q

The large majority (80%) of brain metastases are in what location?

Options: cerebrum, cerebellum, or brainstem

A

Cerebrum

15
Q

What would be your first step in working up the source of a patient’s brain metastases?

A

CT scan of the chest/abdomen/pelvis

16
Q

What are the three options for radiation of brain metastases?

A
  1. Whole brain radiation
  2. Hippocampal-avoidant radiation
  3. Stereotactic radiosurgery
17
Q

What term refers to the condition in which a solid tumor (typically lung, melanoma, or breast tumors) diffusely spreads to the leptomeninges?

A

Leptomeningeal carcinomatosis

18
Q

A patient with untreated leptomeningeal carcinomatosis can expect to live how long?

And with treated leptomeningeal carcinomatosis?

A

4 weeks

4 months

(rapidly fatal)

19
Q

Give the four names for the four grades of astrocytoma:

A

Grade 1 — Pilocytic

Grade 2 — Diffuse

Grade 3 — Anaplastic

Grade 4 — Glioblastoma

20
Q

Glioblastoma multiforme is actually a very aggressive form of __________oma.

A

Glioblastoma multiforme is actually a very aggressive form of astrocytoma.

21
Q

Are glioblastomas benign or malignant?

A

Malignant

22
Q

What are the features of oligodendroglioma growth and IDH genetics?

A

Slow-growing with calcification;

1p/19q codeletion

23
Q

Which primary brain tumor is typically found in either the spinal cord, brainstem, or thalamus and involves histone mutations?

A

Diffuse midline glioma

(associated with K27M and G34R mutations)

24
Q

Which primary brain tumor is associated with HIV and EBV?

A

Primary CNS lymphoma

25
Q

What is the most common pediatric malignancy of the brain?

A

Medulloblastoma

(slight predominance for males)

26
Q

What primary brain tumor is seen in children and is associated with a variety of familial cancer predisposition syndromes (e.g. Li-Fraumeni, Turcot, Gorlin, etc.)?

A

Medulloblastoma

27
Q

What tumor type is described as a “sausage shaped” tumor in the conus medullaris?

A

Ependymoma

28
Q

What is the characteristic histology of an ependyoma?

A

Perivascular psuedorossettes

29
Q

Which size of pituitary adenoma is typically non-secreting?

A

Macroadenomas

30
Q

Pituitary adenomas can either be pituitary macroadenomas (> ___ cm) or pituitary microadenomas (< ___ cm).

A

Pituitary adenomas can either be pituitary macroadenomas (> 1 cm) or pituitary microadenomas (< 1 cm).

31
Q

Mengiomas arise from what tissue layer(s)?

A

The arachnoid mater

(and can thus arise anywhere in the CNS where there’s arachnoid)

32
Q

How does a meningioma appear on imaging?

A

An extra-axial mass with dural tail

33
Q

True/False.

~80% of meningiomas are benign (grade I; surgery only);

~20% are atypical (grade II; surgery and maybe radiation);

<2% are malignant (grade III; surgery and radiation)

A

True.

34
Q

Name a few malignancies associated with paraneoplastic subacute cerebellar degeneration.

A

Gynecological (ovarian, endometrial, and breast cancers)

Small cell carcinoma of the lung

Hodgkin’s lymphoma

35
Q

What are the presenting features of paraneoplastic subacute cerebellar degeneration?

A

Progressive cerebellar dysfunction over a period of several weeks in a patient with an underlying malignancy;

dysarthria, vertigo, gait instability, limb and ocular ataxia, nystagmus, diplopia

(results due to loss of Purkinje fibers)

36
Q

Which auto-antibodies are associated with paraneoplastic subacute cerebellar degeneration in patients with breast cancer?

A

Anti-Yo antibodies; anti-Ri antibodies

37
Q

Which auto-antibodies are associated with paraneoplastic subacute cerebellar degeneration in patients with small cell lung cancer?

A

Anti-Hu antibodies

38
Q

Which auto-antibodies are associated with paraneoplastic subacute cerebellar degeneration in patients with neuroblastoma?

A

Anti-Hu antibodies

39
Q

A patient with breast cancer develops opsoclonus and ataxia. She likely has anti-____ antibodies targeting her _____________.

A

A patient with breast cancer develops opsoclonus and ataxia. She likely has anti-Ri antibodies targeting her cerebellum.

40
Q

An infant presenting with opsoclonus-myoclonus syndrome likely has anti-_____ antibodies and an underlying ____________.

A

A baby presenting with opsoclonus-myoclonus syndrome likely has anti-_Ri (Anna 2)_ antibodies and an underlying neuroblastoma.

41
Q

What is the colloquial term for opsolonus-myoclonus syndrome?

A

‘Dancing eyes, dancing feet’ syndrome

42
Q

A patient with a previous ovarian teratoma presents with S/Sy of encephalitis. MRI shows hyperintensities in her temporal lobes. You suspect her body may have developed antibodies against what?

A

NMDA-receptors

(There were present on the teratoma; there is now cross-reactivity with the CNS.)

43
Q

A patient with a previous thymoma presents with S/Sy of encephalitis. MRI shows hyperintensities in his medial temporal lobes and basal ganglia. You suspect his body may have developed antibodies against what?

A

LGI1

(leading to LGI1-associated encephalitis)

44
Q

What medication used in managing thymomas is associated with severe fatigue, acute kidney injury, respiratory failure, sepsis, and multiple organ failure due to myasthenic crisis?

A

Pembrolizumab

45
Q

What medication type is useful in treating some malignancies by ‘taking the foot off the break’ of T cells (via a mechanism of action in which an inhibitory signal is purposefully blocked)?

A

PD-1 inhibitors and PD-L1 inhibitors

46
Q

A 10 year old presents with chorea one week after an upper respiratory infection.

What do you suspect?

A

Autoimmune issue of the basal ganglia following a S. pyogenes infection

47
Q

A 22-year-old presets with a new onset movement disorder, psychoses, slow writhing movements, and dystonia.

What do you suspect?

A

Anti-NMDA-receptor antibodies

48
Q

A 35-year-old presents with a new-onset movement disorder, altered mental status, and abnormal liver function tests.

What do you suspect?

A

Wilson’s disease

(hepatolenticular degeneration)

49
Q

Following treatment for Hashimoto’s thyroiditis, a female patient presents with neuropsychiatric symptoms and seizures, anti-TPO/thyroglobulin antibodies.

How do you treat her?

A

Steroids

(Hashimoto’s encephalitis, aka steroid-responsive encephalopathy)

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