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33 Cards in this Set
- Front
- Back
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Most common brain tumor
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Metastasis. Comprise slightly more than half of brain tumors. |
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Brain metastases solitary vs multiple on MRI
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~70% of metastases will be multiple on MRI at time of diagnosis |
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Which primary brain tumor is the most frequent to metastazise extraneural |
Meningioma rarely goes to heart and lungs |
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Which cancer is the most likely to produce brain metastases |
*Lung Ca + breast Ca account for > 50% of cerebral mets. |
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Sources of cerebral Mets in pediatrics
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Neuroblastoma, rhabdomyosarcoma and Wilm's tumor |
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Small-cell lung Ca is radiosensitive or radio resistant
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Which is the most common location of brain metastasis |
- 75% are parenchymal. 80% of solitary metastasia are located in cerebral hemispheres. - Cerebellum is a common site of cerebral mets (spread via Batson´s plexus and/or vertebral veins). |
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Melanoma brain metastasis. Common sites of origin? How does it show on CT
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- retina - brain (primary) - nail bed. - Melanoma shows hyperdense on CT because of the melanine. AND MRI: T1 hyperintense and T2 hypointense **Commonly metatasize 70-90% of pts who died from melanoma in autopsies had brain metastasis |
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Radiosensitivy of brain metastasis? |
- Small-cell lung Ca (SCLC). - Germ cell tumors - multiple myeloma Moderate sensitive - Breast Moderate resistant - Colon -Non-small lung cell Ca. (NSCLC) Highly resistant (SRS may be better than WBXRT) - Melanoma - thyroid - Renal cell - Sarcoma - AdenoCa. |
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Radiation therapy for brain metastasis. 1. In pts not considered for surgery dose 2. Pos-op radiation dose 3. Stereotactic radiosurgery usually reserved for what size and how many lesions ** Which cancer receives prophylactic brain radiation |
1. Dose for non surgical metastasis is 30 Gy in 10 fractions over two weeks 2. Pos-op is usually 45-50 WBRXT plus a boost the tumor bed bringing the total tx to 55 Gy. All with low fractions of 1.8 - 2.0 Gy 3. Stereotactic RS si usually reserved for lesions < 3cm and usually less than 3 lesions ** Small-cell lung Ca. is treated with prophylactic brain radiation due to its likelyhood to metastazise to the brain |
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1. With history of treated Ca, which % of brain solitary lesions are mets 2. On the contrary solitary brain mass without Ca. history and negative chest X-ray what percentage are mets |
2. Only 7 % and ~ 87% are primary brain tumors |
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What is the most important prognostic factor in brain mets |
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Karnofsky performance score scale |
100 - Normal, no evidence of disease 90 - Able to carry on normal activity, minor S&S 80 - Normal activity with effort. 70 - Cares for self. Unable to do normal activity or to do active work 60 - Requires occasional assistance. 50 - Requires considerable assistance and f care 40 - Disable: requires special care and assistance 30 - Severely disabled: hospitalized 20 - Very sick: Hospitalized active supportive care 10 - Moribund 0 - Dead |
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Carcinomatous meningitis (AKA leptomeningeal carcinomatosis). Most common primary tumors? S%S, dg by CSF?
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- S&S usually Simultaneous onset of findings in multiple levels of neuraxis, multiple cranial nerve findings are f. (most common VII, III, V & VI) - In LP ~ 45% positive in first study but CSF eventually abnormal in > 95% of cases.
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Which is the most common foramen magnum tumor |
Meningioma |
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Idiophatic intracranial hypertension (AKA pseudotumor cerebri) is often associated with? Can cause? Tx? |
- Can cause blindness (often permanent) from optic atrophy - Tx - Spontaneous resolution is common. - Weight loss, diuretics (acetazolamide, etc) - Optic nerve sheath fenestration (for visual loss without H/A. - Shunt for H/A associated visual loss. ** likely associated with drugs:keprone, lindane, hypervitamosis A. |
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Which neurofibromatosis is more common |
NF I (AKA von Recklinghausen's disease) > 90 % of cases of neurofibromatosis. |
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Diagnostic criteria for NF I (von Recklinghausen's disease) |
- ≥ 6 café au lait spots (present in ≥ 99%) - ≥ 2 neurofibromas - Hyperpigmentation in axila or inguinal areas - ≥ 2 Lisch nodules = pigmented iris hamartomas - Distintive osseus abnormality (ej. sphenoid dysplasia, scoliosis) - A first degree relative with NF I
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NF type I tumors associated with |
- Multiple skin neurofibromas - Hemispheric astrocytomas are the most common IC-tumors. - gliomas usually pilocytic astros - 20% develop plexiform neurofibromas - pheochromocytoma is occasionally present **Meningiomas are not ass with NF 1 |
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What is a plexiform neurofibroma and is associated with?
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Is a tumor from multiple nerve fascicles that grow along the lenght of the nerve is almost pathognomonic of NF type I. |
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All the neurocutaneous disorders except for ataxia-telangiectasia are inhereted in what way
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- There is also a high rate of spontaneous mutations. |
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Other associated conditions beside tumors in NF type I |
- Macrocephaly - Unilateral defect in sup. orbit pulsatile exophtalmus. - 30 to 60 % have mild learning disabilities. - Kyphoscoliosis - Syringomielia - Unidentified bright objects (UBO) in brain/spine MRI. |
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NF type I has an autosomal dominant inheritance, which gene is the affected one and for which protein does it code
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** Spontaneous mutation rate is high 30-50% |
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Diagnostic criteria for NF type 2 (AKA bilateral acoustic NFT)
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- Bilateral vestibular schwannomas. - A first degree relative and either: a. unilateral VS at age < 30@ b. any two of: meningioma, schwannoma, glioma (includes astro, ependymoma), posterior lens opacity (chataracs) Probable dx: - Unilateral VS at age < 30@ and any: meningioma, schwannoma, glioma, posterior lens op. - Multiple meningiomas and either of: schwannoma, glioma or posterior lens opacity |
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What tumors are associated with NF2
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- Multiple intradural spinal tumors are common including intramedullary (specially ependymomas), and extramedullary schwannomas, meningiomas. - Meningiomas, which can be multiple - Retinal hamartomas - Cutaneous schwannomas ** Despite its name is not associated with neurofibromas |
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Beside tumors other clinical characteristics of NF2
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- Chataracts ** Not associated with pheocromocytoma, no intellectual impairment, not associated with Lisch nodules. |
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Sporadic occurrence > 50% |
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Clinical triad of Tuberous Sclerosis (AKA Bourneville's disease)
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Triad: Seizures, mental retardation and sebaceous adenomas. (mm in the face)
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Typical CNS finding in Tuberous Sclerosis. Associated with which other tumor Characteristic patern in CT |
TS is commonly associated with Subependymal giant cell astrocytoma. Can associate with pachygyria or mycrogyria CT shows intracerebral calcifications (usually subependymal). |
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S&S of TS |
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Which neurocutaneous disordes (contain unique neurological findings and bening cutaneous lesions) are of importance for neurosurgery
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- Tuberous Sclerosis - von-Hippel Lindau. - Sturge Weber Syndrome - Racemosa angioma (Wyburn-Mason S.): Midbrain and retinal AVMs |
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In Tuberous Sclerosis what is the chromosomes and proteins involce in the disease
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2 tumor supressor genes (Tuberous Sclerosis complex) TSC1 (chromosome 9q34 encoding for hamartin) and TSC2 (chromosome 16p13, coding for tuberlin. |
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Sturge-Weber Syndrome is characterized by S&S What does X-ray show? |
- Contralateral seizures usually present. usually hemiparesis, hemiatrophy and homonymous hemianopia. * Plain skull films classically show "tram-tracking" calcifications. ** Lobectomy or hemispherectomy may be needed for refractory seizures. Most cases are sporadic. |
