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517444
brain tumours
Descripción
(Malignancy) Paediatrics Mapa Mental sobre brain tumours, creado por v.djabatey el 31/01/2014.
Sin etiquetas
malignancy
paediatrics
paediatrics
malignancy
Mapa Mental por
v.djabatey
, actualizado hace más de 1 año
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Creado por
v.djabatey
hace casi 11 años
51
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Resumen del Recurso
brain tumours
in kids (vs adults)
almost always 1ry
60% are infratentorial
commonest & solid tumour in kids
leading cause of childhood Ca deaths in UK
types
astrocytoma (~40% of cases)
vary from benign to highly malignant (glioblastoma multiforme)
Mx- surgery, radiotherapy +/- chemo
but prognosis poor (<30% survival) @ cerebral site
in cerebellum, slow growing & cystic
good prognosis post surgery
medulloblastoma (~20%)
arises in midline of post fossa
may seed through CNS via CSF
up to 20% have spinal mets @ diag
Mx-surgery, chemo, radiotherapy
prognosis- survival rates improving- 5 year survival about 50%
ependymoma (~8%)
mostly in post fossa
behaves like medulloblastoma
brainstem glioma (6%)
not for biopsy- too risky
very poor prognosis (<10% survival)
craniopharyngioma (4%)
developmental tumour arising from squamous remnant of Rathke pouch
not truly malignant but locally invasive & grows slows in suprasellar region
Mx- surgical excision +/- radiotherapy
prog- good survival but risk of long term visual imp & lifelong pituitary insuff
clinical features
location of tumours
supratentorial
cortex
diag- astrocytoma
commonly in cerebral hemispheres, thalamus & hypothalamus
seizures
hemiplegia
focal neurological signs
typical hx
14 year old, aggressive behaviour @ school, headaches, seizure
midline
diag- craniopharyngioma
visual field loss- bitemporal hemianopia
pituitary failure
growth failure
diabetes insipidus
weight gain
typical hx
10 year old, c/o headaches, vomiting, poor growth, hard to see board @ school
infratentorial
cerebellar (& 4th ventricle)
diag
medulloblastoma
ependymoma
astrocytoma
abnormal eye movements
truncal ataxia
coordination difficulties
typical hx
3 year old vomiting in morning, unsteady on feet, new onset convergent squint
brainstem
diag
brainstem glioma
cranial nerve defects
pyramidal tract signs
cerebellar signs- ataxia
often no raised ICP
typical hx
4 year old, refuses to walk, unable to climb stairs, squint, facial asymmetry & drooling
spinal cord
diag
astrocytoma
ependymoma
primary or mets (depends on level of lesion)
back pain
peripheral weakness of arms or legs
bladder/bowel dysfunction
raised intracranial Pa
kids & teens
headaches-worse in morning
vomiting- esp on waking in morning
behaviour/personality change
visual disturbance
papilloedema
infants
vomiting
separation of sutures/tense fontanelle
head tilt/posturing
developmental delay/regression
increased head circumference
Ix
MRI
best for characterising brain tumours
magnetic resonance spectroscopy
to examine biological activity of tumour
lumbar puncture
not to be done w/o neurosurg advice if any ?raised ICP
Mx
surgery
usually 1st Rx
aims
treating hydrocephalus
providing tissue diagnosis
attempting max resection
anatomical location may mean tumour can't be biopsied
brainstem tumours
even histologically 'benign' tumours can be challenging to survival
use of radiotherapy +/- chemo varies w/ tumour type & pt age
late effects
risks of
neurodisability
growth, endocrine, neuropsychological, educational probs
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