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Flashcards in Mass lesions-neoplasm Deck (28)
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1
Q

Define meningioma.

A

A meningioma is a (usually benign) tumor that develops from coverings of the brian.

2
Q

Name 3 types of gliomas.

A

1) Oligodendroglioma
2) Ependymoma
3) Astrocytoma
- Anaplastic astrocytoma is a high grade glial tumor that develops from astrocytes.
- Glioblastoma multiforme is a malignant glial tumor that develops from astrocytes.

3
Q

What is a medullablastoma and who does it normally affect?

A

A medulloblastoma is a tumor that develops from primative neuroectodermal cells (usually in children).

4
Q

What is a drop metastasis?

A

A drop metastasis is a metastasis, usually from glioblatomas or ependymomas, that occurs through the cerebrospinal system. it typically occurs around the lumbar nerve roots or the lower spinal cord.

5
Q

Define myelopathy.

A

A myelopathy is damage to the spinal cord.

6
Q

Define radiculopathy.

A

A radiculopathy is damage to a nerve root.

7
Q

What is a paraneoplastic syndrome?

A

A paraneoplastic syndrome is a syndrome, usually from development of an autoimmune reaction, where there is damage to neural structures.

8
Q

How are tumors localized?

A

Tumors are localized by their focal effects on the brain.

9
Q

What are the signs that localize tumors?

A
  • Cortical signs: aphasia, hemiparesis, hemianopsia/quadrantanopsia, sensory loss, parietal lobe symptoms (neglect, agnosia), frontal lobe signs (dysinhibition, apathy personality change)
  • Cerebellar: incoordination, ataxia
  • Lateral brain stem: unilateral loss of pin and temperature sense on face
  • Brain stem: cranial nerve palsy
  • Loss of up gaze: dorsal brain stem, pineal region
  • Bitemporal hemianopsia: pituitary region
  • Spinal cord: saddle anesthesia, paraplegia, sphincter dysfunction
10
Q

What are some irritative signs of tumors of the nervous system?

A
  • Radiculopathy is due to irritation of the nerve roots.

- A significant percentage of brain tumors present with seizure when they irritate the cerebral cortex.

11
Q

What are the signs and symptoms of increased intracranial pressure that can be found in brain tumors?

A
  • Awakened from sleep by headache.
  • Papilledema or loss of venous pulsations in fundus of eye may be observed.
  • Cushing response (increase BP with decrease pulse)
  • Signs of herniation (there are several types: subfalcine/cingulate, transtentorial, cerebellar).
  • Transtentorial herniation => dilating pupil (usually ipsilateral) and hemiparesis (usually contralateral).
12
Q

What signs and symptoms are common in tumors of the pituitary region?

A

Endocrine problems or bitemporal hemianopsia are common with tumors of the pituitary region.

13
Q

What signs and symptoms are common in tumors of the pineal region?

A

Failure of upgaze (Parenaud’s syndrome) may be seen with pineal/tectal region neoplasms.

14
Q

Why do symptoms of brain tumors often respond to steroids?

A

Brain tumors, especially metastatic ones, often result in severe vasogenic edema.
- This type of tumor often responds to steroids with some inprovement in symptoms.

15
Q

What are the types of primary brain tumors?

A
  • Glioma
  • Ependymoma
  • Meningioma
  • Lymphoma (either primary or spread from elsewhere)
  • Schwanoma
  • Pituitary adenoma
  • Primitive neuroectodermal tumor
  • Pinealoma
16
Q

Why is it usually impossible to cure a glioma?

A

Gliomas often infiltrate the brain so complete resection is impossible.

17
Q

What glioma is usually resectible?

A

Cerebellar astrocytoma (pilocytic astrocytoma) in children are usually benign and resectable if found early.

18
Q

What tumors are primarily localized to the posterior fossa?

A
  • Many childhood brain tumors are localized to the posterior fossa.
    • Ependymoma, astrocytoma, medulloblastoma
  • Other posterior fossa tumors
    • Meningioma, ependymoma, acoustic neuroma (Schwanoma), cerebellar hemangioblastoma
19
Q

Which astrocytoma has a good prognosis?

A
Cerebellar astrocytoma (Pilocytic astrocytoma)
   - pediatric tumor
20
Q

Which brainstem tumors have poor prognoses?

A
  • Pontine glioma

- Medulloblastoma

21
Q

What are the treatments for brain tumors?

A
  • Surgical resection is possible for benign tumors like meningioma and sometimes for solitary metastasis (if the systemic cancer controllable).
  • Chemotherapy is limited by the blood-brain barrier and only specific types can be used.
    • Sometimes chemotherapeutic agents can be delivered to the intrathecal space.
  • Radiation is often useful for treatment, but it can damage the brain, especially long-term.
22
Q

What are non-metastatic complications to systemic cancers?

A
  • Neurologic symptoms
    • symptoms can be related to a stroke, an infection, side effects of treatment , paraneoplastic syndrome.
  • Subacute cerebellar syndrome
  • Polyneuropathy
  • Myoneural junction disease (weakness)
  • Confusional state.
23
Q

What is the most common cause of tumors of the spine?

A

Most tumors of the spine are metastatic.

24
Q

What are the common signs and symptoms of metastatic tumors of the spine?

A
  • Back pain
  • Acute or subacute myelopathy (initially flaccid weakness, upgoing toes, sensory level over the trunk, bladder and bowel dysfunction)
  • Possible radiculopathy at the level of the tumor.

*The level of back pain and the radiculopathy are the most predictive of the location of the tumor.

25
Q

Why is it critical to identify malignant spinal cord compression early?

A

It is critical to identify malignant spinal cord compression early because the outcome of treatment depends on the severity of deficit at the beginning of therapy.

26
Q

What is the standard therapy for spinal cord metastatic disease?

A

High-dose steroids are often helpful along with radiation therapy are the common initial measures.
- These may be used with or without surgery

27
Q

What are the primary tumors of the spine?

A
  • Rare primary tumors of nerve root
    • Nneurofibromas, Schwanomas, meningiomas, gliomas.
  • Rare tumors inside the spinal cord
    • ependymoma and glioma.
28
Q

How can you evaluate possible metastatic disease affecting the nervous system?

A
  • MRI&raquo_space; CT scans at detecting metastasis
  • CT scans are not very effective unless there is destruction of bone.
  • Plain x-rays are useful when the metastasis involves bone. - Tissue diagnosis is critical to determine the type of tumor.
    • In the future MR spectroscopy holds promise for noninvasive diagnosis.