Suspecting a Mass
Symptoms that would indicate CNS Mass ddx and need for workup
Headache, Seizure, NV, AMS, Numbness Tingling, etc
T/F: primary tumors often metastasize outside of the CNS
FALSE
Radiology finding to differentiate a meningioma
Dural Tail
Describe typical findings of CNS Mets
Typically appear as Multiple rounded, well circumscribed masses that enhance after administration of contrast
Most common management of mets in the brain
Primary palliative care. May consider surgery to minimize symptoms in lower # of tumors but rare.
Diagnostic Study of Choice for suspicion of a CNS Mass
MRI with and without contrast
*Then bx may or may not be needed in addition. (MRI still "study of choice")
General Speed of onset of Primary CNS Tumors
More often slow and gradually developing. Exceptions with aggressive tumors. But generally Mets is much more rapidly growing.
Most Common Symptom of Meningiomas
Seizures
Most common CNS mets causing cancers:
lung (MC), breast, kidney, melanoma and GI tract
An agent to lessen CNS swelling that is contraindicated in CNS lymphoma
Steroids
Development of new blood vessels 2/2 tumor growth
Angiogenesis
Name the Risk Factors for primary CNS tumors
Radiation to the head, MEN1, Neurofibromatosis, Tuberous sclerosis, Retinoblastoma
HIV and IVDA ↑ likelihood of primary CNS lymphoma
Potential findings of a Pituitary Adenoma
Fatigue, lethargy associated with hormone deficiencies, Visual disturbance, menstrual irregularities osteoporosis
Metastatic spread to meninges or spinal cord
Leptomeningeal Metastasis
When would surgical treatment be contraindicated?
Brainstem tumors, When there is high risk of permanent and debilitating neurological dysfunction, When lesions are multifocal (lymphoma)
The Most Common Cause of an adult CNS Mass
Metastasis
Most Common benign primary CNS tumor
Meningioma
Symptoms of: ipsilateral hearing loss, tinnitus, vertigo, HA and facial weakness
Most likely CNS tumor cause.
Acoustic Neuroma
Primary CAs most likely to cause Leptomeningeal Metastasis
breast, lymphoma or leukemia
Reason for lack of frequent chemotherapy use in CNS lesions
Often they do not cross the BBB
Most Common Location of Pediatric CNS tumors
Below the Tentorium
Nerve on which the Acoustic Neuroma grows
Vestibular or Cochlear nerve
Most likely aggressive tumor in adults
Glioblastoma Multiforme
rapid growth leads to acute onset of symptoms, swelling and bleeding
Typical treatment of Leptomeningeal Metastasis
Surgical placement of an intrathecal catheter for chemotherapy to be locally delivered