Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
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
|