Nsp Week 3: Brain Tumors (Mcnall)

Front 1

What is the most common MALIGNANT brain tumor is children?

Back 1

Embryonal/ primitive medulloblastoma

Front 2

What is the most common brain tumor in children?

Back 2

Pilocytic astrocytoma
(benign)

Front 3

What are the 3 most common brain tumors in children?

Back 3

1. Pilocytic astrocytoma
2. Malignant glioma
3. Embryonal/ primitive medulloblastoma

Front 4

What is the most common malignant brain tumor in adults?

Back 4

Glioblastoma

Front 5

What is the most common brain tumor in adults?

Back 5

Meningiomas
(usually benign)

Front 6

Which 2 tumors are associated Neurofibromatosis type 1?

Back 6

1. Juvenile pilocytic astrocytoma (JPA)-- optic pathway, posterior fossa
2. Nerve sheath tumors

Front 7

List 3 tumors associated with Neurofibromatosis type 2.

Back 7

1. Bilateral acoustic schwannomas
2. Meningiomas
3. Spinal cord ependyomas

Front 8

List 2 tumors associated with Von Hippel-Lindau syndrome

Back 8

1. Neuroendocrine tumors
2. Hemangioblastomas

Front 9

List some genetic syndromes that predispose to brain tumors

Back 9

1. NF Type 1
2. NF Type 2
3. Von Hippel- Lindae syndrom
4. Tuberous sclerosis
5. Turcot syndrome
6. Familial glioma
7. Gorlin syndrome
8. Li Fraumeni

Front 10

What types of radiation can predispose a person to brain tumors?

Back 10

1. Ionizing radiation (definite risk)
2. Radiofrequency radiation (less risky, but still a risk)

Front 11

Describe the general differences between the typical locations of brain tumors in children and adults

Back 11

Children -->
Infratentorial, midline tumors
Adults --> Supratentorial, hemispheric tumors

Front 12

Are posterior fossa tumors more common in children or adults?

Back 12

Children

Front 13

More than 50% of all childhood brain tumors originate in which region?

Back 13

Posterior fossa

Front 14

What are some symptoms associated with posterior fossa tumors?

Back 14

1. Nausea and vomiting:
Morning
No diarrhea
> 48 hours

2. Headaches
Morning, better after vomiting
Interrupts play
Wakes up from sleep

Front 15

List 2 general signs of posterior fossa tumors

Back 15

1. Ataxia
2. Cranial nerve palsies
CN VI -- eye deviates medially
CN IV -- eye deviates upwards

Front 16

To diagnose a brain tumor in a child that is vomiting and has headaches, with no focal neurologic deficits, what type of scan should be done?

If the child DOES have focal neurologic deficits, what type of scan should be done?

Back 16

Vomiting and HA only --> noncontrast CT
(check for hydrocephalus)
Focal neurological deficits --> MRI

Front 17

List 3 types of brain tumors that arise in the posterior fossa.

Back 17

1. Medulloblastoma
2. Ependymoma
3. Low grade gliomas

Front 18

List the 3 signs of herniation (Cushing's triad)

What is the treatment?

Back 18

1. Bradycardia
2. Apnea
3. Hypertension

Treatment:
1. Call code blue
2. Hyperventilate

Front 19

List the 3 characteristics of posterior fossa syndrome

Back 19

(cerebellar mutism syndrom)

1. Mutism
2. "Bulbar palsies"
3. Irritability

Front 20

List 5 posterior fossa post-op issues

Back 20

1. Posterior fossa syndrome (cerebellar mutism syndrome)
2. Cranial nerve palsies
3. Ataxia
4. CSF flow blockage
5. Pseudomeningocele

Front 21

List 5 treatments for medulloblastoma

Back 21

1. Surgical resection
2. Radiation therapy to tumor bed
3. Craniospinal radiation therapy
4. Systemic chemotherapy

Front 22

What are some late effects of medulloblastoma surgical resection?

Back 22

1. Posterior fossa syndrome
2. Cranial nerve palsies

Front 23

What are some late effects of radiation therapy for treating brain tumors?

Back 23

1. Endocrinopathies
2. Learning disabilities

Front 24

What are some late effects of chemotherapy for treating brain tumors?

Back 24

1. Hearing loss
2. Magnesium wasting
3. Infertility

Front 25

Describe the common location that ependymomas arise from

Back 25

Floor of the 4th ventricle
(also seen in the brain and spinal cord)

Front 26

Do ependymomas typically spread through CSF?

Do they tend to recur locally or throughout the CNS?

Back 26

No. They UNCOMMONLY spread through CSF

Tend to recur LOCALLY

Front 27

What is the cure rate of ependymomas, if they are not metastatic?

Back 27

80%
(if metastatic, they are incurable)

Front 28

List 2 treatments for ependymomas

Back 28

1. Surgical resection (essential)
2. Conformal radiation therapy

*NO chemotherapy has been proven beneficial

Front 29

Which part of the brain do juvenile pilocytic astrocytomas commonly arise from?

Back 29

Cerebellum

Front 30

How is juvenile pilocytic astrocytoma treated?

Back 30

Usually cured by surgical resection alone

(If tumor is in the optic pathway, however, low doses of chemo and/or radiation therapy is used)

Front 31

List 3 common signs/symptoms of brain tumors

Back 31

1. Cranial N palsies (CN VI, VII, VIII, IX)
2. Hemiparesis
3. Increased intracranial pressure due to hydrocephalus

Front 32

How are brainstem tumors diagnosed?

Back 32

MRI scan

Front 33

Which type of brainstem tumor is almost invariably fatal?

Back 33

Diffuse intrinsic pontine glioma
(brainstem glioma)

Front 34

Diffuse intrinsic pontine gliomas show short-term response to which type of therapy?

Back 34

Radiation therapy
(20% survival at 2 years)

Front 35

What are some signs/ symtpoms associated with optic pathway/ hypothalamic/ pituitary tumors?

Back 35

1. Visual changes (failed eye exam, covers one eye when watching TV, trouble reading first word on next line, using peripheral vision to get around)
2. Endocrinopathies

Front 36

What type of endocrinopathies are associated with optic pathway/hypothalamic/pituitary tumors?

Back 36

1. Growth failure
2. Precocious or delayed puberty
3. Diabetes insipidus
4. Thyroid dysfunction

Front 37

List 3 types of optic pathway/hypothalamic/pituitary tumors

Back 37

1. Optic pathway glioma
2. Germ cell tumor
3. Craniopharyngioma

Front 38

List 5 signs/ symptoms associated with hemispheric tumors

Back 38

1. Hemiparesis
2. Hyperreflexia
3. One side cranial nerve palsies
4. Aphasia
5. Seizures

Front 39

Do high grade gliomas typically present supratentorially or infratentorially?

Back 39

Supratentorially

Front 40

What is the median lifespan of patients with high grade gliomas?

Back 40

9 months
(even with good resection and RT)

Front 41

How are meningiomas usually treated?

Back 41

Surgical resection
(usually curable)

Front 42

What is the common presenting symptom of meningioma?

Back 42

Headaches

Front 43

Are tumors in infants more often supratentorial or infratentorial?

Back 43

Supratentorial

Front 44

What are some signs/ symptoms of brain tumors in infants?

Back 44

1. Large head w/ open sutures and fontanelles
2. Sunset eyes
3. Loss of developmental milestones
4. Irritability
5. Anorexia

Front 45

List 4 types of brain tumors that are seen in infants

Back 45

1. Atypical teratoid rhabdoid tumors
2. Primitive neuroectodermal tumors
3. High grade glioma
4. Choroid plexus carcinoma