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neuro_iswartz

neuro_iswartz

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Published by: api-3704562 on Oct 16, 2008
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05/09/2014

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t raboco1
B
BR
RA
AI
IN
NT
TU
UM
MO
OR
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Intracranial Tumors
\ue000Cause mass ef f ect , dysf unct ion/ dest ruct ion of adj acent
neural structures, swelling, abnormal electrical activity
or combinat ion
\ue000Supratentorial tumors
\ue001FND
\ue001CL weakness
\ue001Visual field deficit
\ue001Headache
\ue001Seizure
\ue000Infratentorial tumors
\ue001Hydrocephalus\ue004\ue001 ICP\ue004 compression of CN4\ue004
headache, n/ v, diplopia
\ue001RARE sei zures
\ue000Cerebellar hemisphere/ brainst em dysfunct ion
\ue001Ataxia, nystagmus, CN palsies
\ue000ALL px suspect for brain tumor\ue004 MRI (w/ AND w/ o
gadolinium); evaluat ion st udy of choice!
\ue000Initial Mx:
\ue001Dexamet hasone (if edema)
\ue001Phenyt oin (suprat ent orial t umors only)
Met ast at ic Tumors
\ue000
In decreasing frequency
\ue001Lung
- more t han half
\ue001Br east
-

\ue001Kidney
\ue001GI Tract
\ue001Mel anoma

\ue000Travel hematogenously & seed gray-white junction

(other locations: cerebellum & meninges\ue004 w/ c can lead to carcinomatous meningitis: Leptomeningeal carcinomat osis)

\ue000Mx:

\ue001Depends on primary t umor
\ue001Tumor burden
\ue001Px\u2019s medical condition
\ue001Locat ion & number of met ast ases

\ue000Craniotomy is NOT advisable unless ALL detectable
met ast ases can be accessed/ resect ed
\ue000Surgery SHOULD be followed by whole brain radiation
t herapy\ue005\ue001 average survival t o 8 mont hs
\ue001Radiation may be delayed until recurrence in low
grade t umors
\ue000Stereotactic surgery (gamma knife)\ue004 multiple
metastases; gross total resection w/ o unacceptable
devast at ing neurologic deficit
Glial Tumors
\ue000Glial cells\ue004 provide the anatomic & physiologic
support for neurons & their processes
\ue000ASTROCYTOMA

\ue001Most common primary CNS neoplasm
\ue001\u201c Glioma\u201d
\ue001Grade:

\ue001I \ue004low grade
\ue001II \ue004low grade
\ue000Median survival: 8 years
\ue001III \ue004 anaplast ic ast rocyt oma
\ue000Median survival: 2-3 years
\ue001IV \ue004glioblast oma mult iforme (GBM)
\ue000Median survival: 1 year
\ue0002/ 3 of all ast rocyt omas
\ue001Do NOT infiltrate brain:
\ue001Juvenile pilocyt ic ast rocyt oma
\ue001Pleomorphic xant hoast rocyt oma
\ue000(Bot h) are circumscribed, low grade & w/
good prognosis
\ue001Higher grade:

\ue001Hypercellularit y
\ue001Nuclear at ypia
\ue001Endovascular hyperplasia

\ue001Necrosis \ue004 OnLy w/ GBM; required for Dx
\ue000OLI GODENDROGLI OMA

\ue00110% of gliomas
\ue001\ue002 sei zur es
\ue001CT/ MRI:\ue002 calcif icat ions &\ue002 hemorrhages
\ue001Grade I \u2013 IV
\ue001Prognosis is bet t er t han ast rocyt oma
\ue001Prognosis: 2-7 years
\ue001Respond t o:

\ue001Procarbazine
\ue001Lomust ine (CCNU)
\ue001Vincristine (PCV)

\ue000EPENDYMOMA
\ue001Lining of ventricular system: cuboidal/ columnar
ependymal cells
\ue001Infrat ent orial\ue004 2/ 3 adult
\ue001From floor of 4th ventricle (off the back of the
brainst em\ue004 making gross t ot al resect ion of t en
impossible)
\ue000Mx: Suboccipital craniotomy & midline
separat ion of t he cerebellar hemisphere
\ue001Suprat ent orial\ue004 pediat ric
\ue001From lateral / 3rd ventricle
\ue001@ Foramen of Luschka
\ue001CPA t umor
\ue001\u201c drop met s\u201d \ue004spread @ CSF t o spinal cord
\ue001S/ S: Headache, n/ v, vertigo\ue004 2ndary to\ue001 ICP
from obstruction to CSF flow
\ue001Hi st ol ogy:
\ue001Papillary ependymoma
\ue001Anaplast ic ependymoma \ue004\ue001mitotic activity &
areas of necrosis
\ue001\ue002 Post op Radiat ion Therapy
\ue001CSF spread (document ed by LP or CEMRI) \ue004w/
whole spine radiat ion
\ue000CHOROID PLEXUS PAPILLOMA
\ue001Many small vascular tufts covered w/ cuboidal
epit helium
\ue001Part of int erface bet ween blood & brain
\ue001Choroid cells\ue004 creat e CSF from blood
\ue001Choroid plexus CARCINOMAS (rare, pediatric)
\ue001Occur in infants (supratentorial @ lateral ventricle)
\ue001\u2026in adult s (infrat ent orial @ 4th vent ricle)

\ue001well circumscribed, ext ensive vasculat ure
\ue001S/ S\ue001 I CP
\ue001Tx excision
\ue001DO NOT USE Radi at i on or Chemot x

t raboco2
Neural Tumors & Mixed Tumors
\ue000Medulloblast omas
\ue001PNETS\ue004 most common; arise from bipot ent ial cells
(capable of differentiating into neurons or glial
cells)
\ue0011st and 3rd decade
\ue001most common pediatric malignant tumor; usually
midline & @ cerebellum
\ue001S/ S\ue001 I CP
\ue001Hi st o:
\ue001Densely packed small round cells w/ large
nuclei & scant cyt oplasm
\ue001NOT encapsulat ed, frequent ly disseminat ed
\ue001Tx:
\ue001Surgical resection \ue004radiation tx \ue004 chem ot x
\ue000Gangl iogl ioma

\ue001Mixed t umor (neurons & glial cells)
\ue001First 3 decades
\ue001Medial temporal lobe\ue004 seizure
\ue001Circumscribed masses that may contain cysts/

calcium
Neural Crest Tumor
\ue000Mult ipot ent
Miscellaneous t umors
\ue000MENI NGI OMA
\ue001From arachnoid cells (arachnoid mat t er)
\ue001From dura matter (grossly & MRI)\ue004 \u201c Dural-based
t umors\u201d
\ue001Locat i ons:

\ue001Fal x
\ue001Convexities (cerebral hemispheres)
\ue001Sphenoid wing
\ue001Less common:

\ue000Foramen magnum
\ue000Olfact ory groove
\ue000Inside Lat eral vent ricle

\ue001Most ly slow growing, encapsulat ed, benign
\ue001If malignant \ue004invade adjacent bone or into
cort ex
\ue001Previous cranial irradiat ion increases incidence
\ue00110%- multiple
\ue000Vest ibular Schwannoma (Acoust ic Neuroma)
\ue001Arise from the superior half of the vestibular
port ion of vest ibulocochlear nerve (CN 8)
\ue001S/ S:

\ue001Progressive hearing loss
\ue001Tinnit us
\ue001Balance difficulty
\ue001Large t umors:

\ue000brainst em compression
\ue000obst ruct ive hydrocephalus
\ue001If bilateral\ue004 NF 2
\ue001Chromosome 22 mut at ion
\ue001\ue001 incidence of spinal & cranial meningiomas &
gliomas
\ue001Tx: microsurgical resect ion or gamma knife
\ue001Main complicat ion: Damage t o CN 7 \u2013 Facial Nerve
(because it runs t hrough t he int ernal audit ory canal
w/ CN 8)\ue004this risk\ue001 with\ue001 tumor diameter
\ue000Pit uit ary Adenoma

\ue001Ant erior Pit uit ary (Adenohypophysis)
\ue001Microadenoma (<1cm) / Macro
\ue001Functional (endocrine) / Nonfunctional (mass

effect )
\ue001Endocrine Dysfunct ion
\ue001Cushi ng\u2019 s di sease \ue003 ACTH sec r et i on
\ue001Forbes-Albright syndrome \ue003 PRL secret ion
\ue000Tx: Dopamine
\ue000Sx if persistent mass effect
\ue001Acromegal y \ue003 Growt h hormone secret ion
\ue001S/ S
\ue001Visual field defects \ue003 compression of optic
chiasm
\ue001Panhypopit uit arism \ue003compression of entire
gl and
\ue001Hemorrhage \ue004Pituitary apoplexy
\ue000Headache
\ue000Visual disturbance
\ue000\ue002 mental status
\ue000endocrine disfunct ion
\ue001
Mx: Transphenoidal Sx (t hrough t he nose)
\ue000Hemangiobl ast oma
\ue001@ Post erior fossa
\ue00120%\ue004 Von Hippel-Lindau disease
\ue001mult isyst em neoplast ic d/ o
\ue001al so assoc w/ :

\ue000Renal cell CA
\ue000Pheochromocyt omas
\ue000Ret inal angiomas

\ue001Appear as cyst ic w/ mural nodule (enhancing t umor
@ cyst wall)
\ue001Mx: En bloc resect ion of mural nodule alone is
sufficient
\ue001Sx resection is curative for sporadic (non-VHL)
t umors
\ue001Pat ho:
\ue001Thin walled vascular channels (internal
debulking may be bloody)
\ue000Lymphoma
\ue001Primarily @ CNS or 2ndary t o syst emic disease
\ue001Incidence:
\ue001Transplant px
\ue001AIDS
\ue001S/ S:
\ue001Mental status changes
\ue001Headache \ue003\ue001 I CP
\ue001CN palsy \ue003 lymphomatous meningitis
(~carcinomat ous meningit is)

\ue001Hyperdense on CT (dense cellularit y)
\ue001Sx excision: little role
\ue001Tx: steroids, whole brain radiation, chemotherapy

(intrathecal methotrexate)
t raboco3
Embryologic Tumors
\ue000Failure to involute or differentiate properly
\ue000Craniopharyngioma

\ue001Benign, cyst ic lesions in children
\ue0012nd peak of occurrence (50 y/ o)
\ue001All pediatric & 50% of adult craniopharyngiomas

calcify
\ue001S/ S:
\ue001Compression of adjacent structures (optic
chiasm)
\ue001Pituitary/
hypot halamic
dysf unct ion
or
hydrocephalus may develop
\ue001Sx:
\ue001Excision is easier in children (soft & suckable
t umor)
\ue001Adult tumors (firm & adherent to adj acent vital
st ruct ures)
\ue001Complicat ions from Sx:

\ue001Visual loss
\ue001Pit uit ary endocrine hypofunct ion
\ue001Diabet es insipidus
\ue001Cognitive impairment (basal frontal inj ury)

\ue000Epidermoid
\ue001Cystic lesions w/ stratified squamous epithelial
walls from trapped ectodermal cell rests
\ue001Grow slow & linearly by desquamation into cyst
cavit y
\ue001Cont ain:

\ue001Kerat in
\ue001Cholest erol
\ue001Cellular debris

\ue001CPA Angl e
\ue001Mollaret\u2019 s Meningitis\ue004 recurrent bouts of aseptic
meningitis due to release of irritating cyst contents
int o subarachnoid space
\ue000Dermoid
\ue001Less common t han epidermods
\ue001Contain hair follicles, sebaceous glands, squamous
epit helium
\ue001Midline structures
\ue001Bacterial meningitis if associated with skin sinus
t ract
\ue000Terat oma
\ue001Midline (often @ pineal region\ue004 area behind 3rd
vent ricle, above midbrain & cerebellum)
\ue001Contain elements from all 3 germ layers: endo,
meso & ect oderm
\ue001Cont ain skin, cart ilage, GI glands, t eet h
\ue001If w/ more pirimit ive st ruct ures = more malignant
B
BR
RA
AI
IN
NA
AB
BS
SC
CE
ES
SS
S
\ue000Encapsulat ed infect ion w/ in brain parenchyma
\ue000Spread hemat ogenously in px w/

\ue001endocardit is
\ue001int racardiac
\ue001int rapulmonary R\ue004L shunt s
\ue001migrat ion from sinuses or ear
\ue001direct seeding by penet rat ing t rauma

\ue000Disorganized cerebrit is\ue004 preceedes abscess f ormat ion
\ue000S/ S:

\ue001Headache
\ue001Nausea
\ue001Let hargy
\ue001FND (hemiparesis)
\ue001Ext remis (???)\ue004 if abscess rupt ures int o vent ricular

syst em
\ue000CT/ MRI: Well demarcated, ring enhancing, thin walled
lesions w/ assoc edema & mass effect
\ue000Blood & CSF cult ures: rarely give definit ive diagnosis

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