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161 Cards in this Set

  • Front
  • Back
What are the 3 most common intracranial tumors in children?
1) cerebellar astrocytoma
2) medulloblastoma
3) ependymoma
What is the most common spinal cord tumor in children?
astrocytoma
What are the most common intracranial tumors in adults?
1) metastatic
2) GBM
3) astrocytoma, oligodendroglioma
What is the most common tumor in intramedullary spinal cord adults?
ependymoma
What tumor has the best prognosis of all the primary brain tumors?
pilocytic astrocytoma
What is the most common pineal region tumor?
germinoma
What are the most common tumors that metastasize to brain?
Bad Stuff Like To Kill Glia
Breast
Melanoma (Skin)
Lungs (NSCLC)
Thyroid
Kidney
GI
What are the most common hemorrhagic tumors?
Bad Cancers See Red
Breast
Choriocarcinoma
Skin (melanoma)
Renal
What is the differential diagnosis for a pineal region mass?
The Pineal Place Makes More Anxiety Like GED
1) Teratoma
1) Pinealocytoma
2) Pinealoblastoma
4) Meningioma
5) Metastasis
6) Astrocytoma
7) Lipoma
8) Germinoma
9) Epidermoid
10) Dermoid
What is the differential for temporal lobe tumors?
1) Ganglioglioma
2) DNET
3) PXA
4) Astroctyoma
5) Low Grade Glioma
What is the differential diagnosis for pituitary tumors?
SATCHMOE

1) Sarcoid
2) Adenoma, Aneurysm, Apoplexy
3) Teratoma
4) Craniopharyngioma
4) Histiocytosis, Hypothalamic Hamartoma
5) Meningioma, Mets
6) Optic Glioma
7) Epidermoid/Dermoid
8) Lymphoma
What is the differential diagnosis for Clivus tumors?
Chordoma, chondrosarcoma, osteosarcoma
What is the differential diagnsis for intraventricular tumors?
1) Choroid plexus papilloma
2) Ependymoma
3) Medulloblastoma
4) Choroid Plexus Carcinoma
5) Lymphoma
6) Neurocytoma
7) SEGA
8) Colloid cyst
9) Subependymoma
10) Astrocytoma-Pilocytic
11) Olgiodendroglioma
12) Hemangioblastoma
13) Exophytic brainstem glioma
What is the differential diagnosis for CPA masses?
1) Schwannoma
2) Meningioma
3) Epidermoid/Dermoid
What is Li Fraumeni Syndrome?
Inherited cancer syndrome characterised by
a) soft tissue tumors
b) breast
c) glioma
d) brain tumors
p53 gene abnormality
What is Cowden's syndrome?
multiple hamartomas
Lhermitte Duclos syndrome (dysplastic gangliocytomas of cerebellum)
breast ca
thyroid ca
autosomal dom syndrome
What is Turcot's syndrome?
familial adenomatous polyposis
PNET
gliomas
What is Gardner's syndrome?
multiple tumor types with polyposis
osteoma
soft tissue tumor
What is the median survival for GBM?
2 years in 27% after chemoradiation std treatment
14 month median survival post treatment
What is the median survival for gliomatosis cerebri?
2 years 50%
What is treatment for gliomatosis cerebri?
chemotherapy(no role for surgery, diffuse, infiltrating
What is the usual age range for PXA?
20s to 30s (college student)
What is the prognosis for PXA?
5 year 81%
10 year 70%
What is treatment for PXA?
surgical resection should be curative, if recurs radiation/chemo
What percentage of patients with TS have SEGA?
14%
What is the prognosis for SEGA/TS?
neuroimaging unless symptomtaic/hydrocephalus
Where does SEGA tend to occur?
foramen of Monroe
When does SEGA tend to occur?
1st and second decades of life
What percentage of patients with optic glioma have NF-1?
50%
What percentage of patients with NF1 have optic gliomas?
1-7% of children with NF1
What is treatment for pontine gliomas?
radiotherapy
What is the genetic testing which should be done on tumor cells for patients with oligodendrogliomas?
LOH of 1p19q
What is the usual age of presentation of oligodendroglioma?
30s to 50s
What is the prognosis for oligodendroglioma?
75% 5 years
mean 4-11 years
Where do oligodendrogliomas tend to present?
frontal - temporal - parietal
Why do they have fried egg appearance on histopathology?
fixation artifact
What percentage of intracranial ependymoma occur in children?
2/3
What percentage of intraspinal ependymoma occur in adults?
90%
What are the most common ages of presentation for ependymoma?
bimodal peak
children
and 4th decade
What are the characteristic histopath findings of ependymoma?
perivascular pseudorosettes
What percentage of these tumors may have drop metastasis?
5% image the entire neuraxis
What is the genetic testing which should be done on tumor cells for patients with oligodendrogliomas?
LOH of 1p19q
What is the usual age of presentation of oligodendroglioma?
30s to 50s
What is the prognosis for oligodendroglioma?
75% 5 years
mean 4-11 years
Where do oligodendrogliomas tend to present?
frontal - temporal - parietal
Why do they have fried egg appearance on histopathology?
fixation artifact
What is the usual age of presentaiton for ependymoma?
bimodal childhood and 4th decade
What is the characteristic histopath appearance of ependymoma?
perivascular pseudorosette (vascular surorunded by an acellular area) opposed to Homer-Wright which are cells surrounding an area without a blood vessel
Where do myxopapillary ependymomas tend to occur?
filum terminale
What are the char histopath findings in myxopapillary ependymoma?
similar to ependymoma but with pools of mucin
What is the treatment for ependymoma?
surgery and radiation (chemo subopt and only reserved for people who can't undergo xrt)
What age do gangliogliomas tend to occur?
first 3 decades
What is the usual presentation of ganglioglioma?
seizures
Where do gangliogliomas have a predilection for?
temporal-frontal-parietal
What is the usual treatment for gangligolioma?
surgical resection (radiation resurved for recurrent disease)
What should be in the differential diagnosis for cystic with a mural nodule?
ganglioglioma
pxa
hemangioblastoma
lymphoma
When do central neurocytomas tend to occur in lifetime?
rare but 20s to 40s does not occur in children
Where do central neurocytomas tend to occur?
intraventricular heterogenous enhancement foramen of Monro; makes up 50% of all intrave
Where do DNET tumors tend to occur?
temporal lobe, benign prognosis, surgical resection for symptomatic cases
What is Lhermitte Duclos disease?
dysplastic gangliocytoma of cerebellum
assoc. with Cowden's disease
occurs in 4th decade
When do central neurocytomas tend to occur in lifetime?
rare but 20s to 40s does not occur in children
Where do central neurocytomas tend to occur?
intraventricular heterogenous enhancement foramen of Monro; makes up 50% of all intrave
Where do DNET tumors tend to occur?
temporal lobe, benign prognosis, surgical resection for symptomatic cases
What is Lhermitte Duclos disease?
dysplastic gangliocytoma of cerebellum
assoc. with Cowden's disease
occurs in 4th decade
When do central neurocytomas tend to occur in lifetime?
rare but 20s to 40s does not occur in children
Where do central neurocytomas tend to occur?
intraventricular heterogenous enhancement foramen of Monro; makes up 50% of all intrave
Where do DNET tumors tend to occur?
temporal lobe, benign prognosis, surgical resection for symptomatic cases
What is Lhermitte Duclos disease?
dysplastic gangliocytoma of cerebellum
assoc. with Cowden's disease
occurs in 4th decade
What syndrome is this disease associated with?
Cowden's syndrome and Lhermitte-Duclos disease
What is the age range and usual location of these tumors?
rare tumors
1st 2 years of life
large cystic with dural attachments and predilection for frontal/parietal
What is the age of presentaiton for medulloblastoma?
bimodal children and 20s
What are the characteristic histopath features of medulloblastoma?
small blue cell tumor with Homer Wright rosettes (lack central vascular component)
Where do medulloblastoma occur?
posterior fossa midline cbl/vermis in children and cbl hemispheric in adults
What is the treatment for medulloblastoma?
surgery and craniospinal irradiation (b/c of predilection for dissemination)
What is the prognosis for medulloblastoma?
5 year survival rate 75% children older than 3 and 50% for younger than 3
When do neuroblastoma tend to occur?
first 5 years of life
What are the characteristic imaging findings for neuroblastoma?
periventricular frontal/parietal lobe
cystic/hemorrhagic/necrotic regions
What neurologic symptoms tend to occur with neuroblastoma?
encephalopathy, opsoclonus, myoclonus
What is the most common benign primary brain tumor?
meningioma
What is the peak incidence of meningioma?
50s to 70s and children
What percentage of meningiomas tend to be multiple?
10%
What are the most common locations for meningioma
parasagittal
convexity
sphenoid rege
tuberculum sellae
olfactory groove
falx
What is the treatment for meningioma?
surgical resection
stereotactic radiosurgery reserved for those with difficult to reach tumors
What is the peak incidence for hemangioblastoma?
50s to 70s
What percentage of hemangioblastomas occur secondary to Von Hippel Lindau?
10%
What is a hemangioperictyoma?
unclear origin, like a meningioma that strongly enhances but see flow voids and vasculature
What is the rate of recurrence with hemangioperictyoma?
60 to 80%
What is true of germ cell tumors and gender predilection?
tend to ocur exclusively in males for germ cell tumors and predominaly male in teratomas
What are the features of germ cell tumors?
signs of compression, ICP and endocrine dysfunction/precocious puberty
What is the differential for intradural extramedullary tumors?
neurofibroma
schwannoma
neurofibrosarcoma
meningioma
paraganglioglioma/dermoid/epidermoid in the filum terminale region
What is the differential for intradural intramedullary lesions?
ependymoma (adults)
astrocytoma( children)
syrinx
drop mets medulloblastoma
intramedullary mets
What is treatment for intramedullary tumors?
avascular character of tumors surgical resection may be a mainstay of treatment
What type of complications can occur with cisplatin?
neuropathy
ototoxicity
ganglionopathy
vestibulopathy
encephalopathy
What complications neuro can occur with methotrexate?
aseptic meningitis
myelopathy
What complications can occur with cytarabine?
aseptic meningitis
cerebellar ataxia
What neurologic symptoms can occur with vinca alkaloids?
neuropathy
cranial neuropathies
auatonomic nueopathy
What neurologic symptoms can occur with 5 FU?
cerbellar ataxia
What neuro sx can occur with PCV?
neuropathy (peripheral and autonomic)
encephalopathy
What neuro sx can occur with nitrosureas?
seizures
encephalomyelopathy
blindness
What types of encephalopathy may occur with XRT?
acute- uring treatment
early delayed 3-8 wks post XRT with edema/mass effect
Late delayed- 13-18 wks post XRT chronic dementia, ventriculomegaly
What type of myelopathy may occur with radiation to spinal cord?
Acute- 3-6 months, Lhermitte's/paresthesias; transient
Delayed- gradual onset/sensory symptoms, urinary incont/weakness (14-19 mos. after)
Who is at risk for optic neuropathy after radiation?
Usually 1 year after and tends to occur in patients with radiation to orbits, paraorbital region, pituitary or stereotactic radiosurgery
When does motor lumbosacral polyradiculopathy and LMN syndrome tend to occur?
subacute onset, gradual progression, unilateral or bilateral leg weekness, 4 months to 1 year after completion
What are the characteristics of Niacin deficiency?
Pellagra: Diarrhea, Dementia, Dermatitis
Neuro: myelopathy, spastic paraparesis, dementia, hyperkeratotitc dermatitis
What are the characteristics of B6 (pyridoxine deficiency)?
seizures in infants
polyneuropathy sens>motor
What are the clinical features of B6 excess?
polneuropathy or polyganglionopathy sensory
What adults usually get B6 deficiency?
rare unless on Isoniazid, penicillamine, hydralazine
What are the features of thiamine deficiency?
Wernicke Korsakoff
Beriberi length-dependent axonal sensorimotor polyneuropathy +/- cardiac involvement
How would one diagnose thiamine deficiency?
erythrocyte transketolase activity
What are the features of Vitamin E deficiency?
cerebellar ataxia, areflexia, large fiber involvement (acanthocytosis, retinitis pigmentosa, hemolytic anemia)
What conditions are associated with Vitamin E deficiency?
abetalipoproteinemia and cystic fibrosis (fat soluble vitamin)
Where does organic mercury tend to occur neurologically?
predilection for dorsal root ganglia, calcarine cortex, cerebellar granular layer
What symptoms occur with thallium toxicity?
painful sensorimotor length-dependent polyneuropathy
alopecia
How does one get exposure to thallium?
pesticides
How does one get exposure to trichloroethylene?
silk screenng, electronic cleaning
What are the symptoms of trichloroethylene?
trigeminal neuropathy
What are the features of lead exposure?
motor neuropathy
wristdrop
basophilic stippling of the RBC
microcytic hypochromic anemia
Why is there a predilection for posterior circulation during hypertensive encphalopathy?
the posterior circulation has less sympathetic innervation than anterior circulation
What conditions can lead to RPLE?
cocaine, amphetamines
cyclosporine
hypertension
pheo
ecclampsia
What are the clinical features associated with CPM or XPM?
locked-in, coma, lethargy, pseudobulbar palsy, spastic paraparesis
What are the characteristics of uremic neuropathy?
mild autonomic sx, progressive weakness, distal sensorimotor polyneuropathy-axonal
uremic mononeuropathies (increased with AV fistula
What is the difference between uremic encephalopathy and dialsyis encephalopathy?
uremic-acute confusion, apathy, slurred speech, paranoia, asterixis
EEG with triphasic waves
dialysis-chronic progressive
aphasia
response to benzos
What is the most common cause o unilateral asterixis?
thalamic hemorrhage
What causes saxitoxins?
paralytic shellfish
What is unique about saxitoxin compared to ciguatoxin?
saxitoxin- block Na channel
no GI sx
paralysis
ciguatoxin- opan Na channels
GI sx
sensory/dysesthesias/paresthesias hot-cold changes
Wha are the features of amnestic shellfish poisoning?
domoic acid, glutamat receptor agonist (mussels)
GI sx
seizures, hemiparesis, opthalmoplegia, neuropathy, coma; memory impairment
What are the toxins in pufferfish?
tetrodotoxins block voltage gated Na channels
What are the symptoms of pusherfish poisoning?
paresthesias perioral, paralysis, sensation of floating, GI symptoms, death within 4-6 hours due to arrhythmia or respiratory failure
What is MOA of alpha bungarotoxins?
postsynaptic blockade of AchR
What is the MOA of Bbungarotoxin?
presynpatic blockage of Ach release
What is the MOA of black widow spider?
latrotxin presynpatictic faciliation then depletion of Ach
What is the toxin in scorpions?
tityustoxin
What is the MOA of scorp;ion?
faciliation of Ach release and post-synaptic activation of voltage-gated Na channels
What is the MOA of amanita mushrooms?
block GABA and cholinergic
What are the clinical sx of methanol toxicity?
necrosis of optic nerves (vlurred vision, permanent visual loss) and putamina (h/a, encephalopathy, sz)
leads to CP fuailure, coma, death
What is the treatment for methanol poisoning?
4 methyl 1H pyrazole (fomepizole)
How do organophosphate poisoning work?
acute cholinergic toxicity by blocking acetylcholinesterase inhibitors
What could lead to toluene exposure?
nail polish, paint, thinners, glues, dyes
What are the symptoms of toluene intox?
euphoria, disinhibition,remor, crebellar sx, optic neuropathies and other cranial neuropathies
How would one diagnose toluene toxicity?
hippuric acid
How would one diagnose carbon disulfide toxicity?
urine metabolite 2-thiothizolidine-4-carboxylic acid
Besides encephalopathy, what other neuro features could carbon disulfide exposure present with?
sm polyneuropathy (sensory)
cognitive d/o
pyramidal sx
optic nueopathy
What are the features of hexane or solvent exposure?
euophoria, hallucinations
SM polyneuropathy
What are the features of acrylamide exposure?
gradual encephalopathy and peirpheral neuropathy
What are the features of organic mercury poisoning?
cerebellum, dorsal root ganglion and ccalcarine cortex (deafness, dysarthria, motor neuron like syndrome UMN + LMN)
What are some features of inorganic mercury exposure?
peripheral neuropathy, personality changes
Besides encephalopathy, what other neuro features could carbon disulfide exposure present with?
sm polyneuropathy (sensory)
cognitive d/o
pyramidal sx
optic nueopathy
What are the features of hexane or solvent exposure?
euophoria, hallucinations
SM polyneuropathy
Besides encephalopathy, what other neuro features could carbon disulfide exposure present with?
sm polyneuropathy (sensory)
cognitive d/o
pyramidal sx
optic nueopathy
What are the features of acrylamide exposure?
gradual encephalopathy and peirpheral neuropathy
What are the features of hexane or solvent exposure?
euophoria, hallucinations
SM polyneuropathy
What are the features of organic mercury poisoning?
cerebellum, dorsal root ganglion and ccalcarine cortex (deafness, dysarthria, motor neuron like syndrome UMN + LMN)
What are the features of acrylamide exposure?
gradual encephalopathy and peirpheral neuropathy
What are some features of inorganic mercury exposure?
peripheral neuropathy, personality changes
What are the features of organic mercury poisoning?
cerebellum, dorsal root ganglion and ccalcarine cortex (deafness, dysarthria, motor neuron like syndrome UMN + LMN)
What are some features of inorganic mercury exposure?
peripheral neuropathy, personality changes
What are some features of managese exposure?
parkinsonism, hypophonia, headaches, neuropsych manifestations
What are some features of arsenic poisoning?
mees lines
optic neuropathy
painful peripheral distal polyneuropathy
hyporeflexia
What is the treatment for arsenic poisoning?
DMSA chelation therapy
What are some neuro conditions associated with too much vitamin A?
pseudotumor and pdd
What is associated with Vitamin A deficiency?
night blindness