Pathophysiology Test 3: Neuropathophysiology 2: hydrocephalus, tumors

Question Answer ***two types of hydrocephalus obstructive (due to obstruction of CSF flow) and communicating (impaired re-absorption of CSF at arachnoid villi anesthesia management of hydrocephalus same as that of intracranial htn (because it causes intracranial htn!) Cranial tumors are classified as _____ (2) primary (coming from the brain itself) and metastaic intracranial Tumors originate from what cell types virtually any cell type within the CNS ***_____ tumors are more common in adults and present with ______ supratentorial tumors; headache, seizures, new neurologic deficits ***_____ tumors are more common in children and present with ______ infratentorial tumors; obstructive hydrocephalus and ataxia intracranial tumors: treatment and prognosis depend on tumor type and location intracranial tumors: Most prevalent neuroglial cells in the CNS and give rise to many types of infra/supratentorial tumors astrocytoma The least aggressive class of astrocyte-derived tumors well differentiated, low grade gliomas (grade 1) ***Astrocytomas: low grade (grade 1) gliomas would show what with contrast minimal enhancement ***Astrocytomas: high grade (grade 4) glioblastoma multiforme would show what with imaging ring-enhancing lesion reflecting central necrosis and surrounding edema (which is ***microscopic infiltration*** of the normal brain) – makes resection inadequate) ***life expectancy of glioblastoma multiform (grade 4) astrocytomas? weeks life expectancy of low grade astrocytoma (grade 1) gliomas? high – just needs a little radiation ***Astrocytoma that that is famous for disruption of the blood brain barrier anaplastic astrocytomas Astrocytomas: anaplastic astrocytomas would show what with contrast contrast enhancing ***Astrocytomas: anaplastic treatment resection, radiation, or chemotherapy Cranial tumors: arise from myelin-producing cells within the CNS oligodendrogliomas this cranial tumor type is radioresistant oligodendrogliomas (this is why resection is the treatment of choice) ***oligodendrogliomas act like anaplastic astrocytomas or glioblastoma multiform at what stage of their development later in their course This tumor arises from cells lining the ventricles and central canal of the spinal cord ependymoma ependymoma most common location floor of the fourth ventricle Which brain tumor is similar to glioblastoma multiforme in its presentation and similar to low grade gliomas in its victims? ependymomas – infiltrates surrounding tissues and presents in childhood and young adulthood ependymomas prognosis depends on completeness of its resection if you had to have a brain tumor – which one would you want and why? meningioma – usually extraaxial (arises outside the brain), slow growing, good barriers (easy to excise), benign (***malignant versions are rare), great prognosis because of their slow growth, these tumors can be very large at the time of diagnosis meningiomas What cells do meningiomas arise from? arachnoid cap cells pituitary tumors arise from cells of the ____ anterior pituitary gland this form of tumor usually goes along with other body tumors pituitary tumors (many times with tumors of the parathyroid gland and pancreatic islet cells) as a part of multiple ***endocrine neoplasia type I two forms of pituitary tumors functional and nonfunctional curative for most pituitary tumors surgical resection via the transphenoidal approach or open craniotomy pituitary symptoms are due to dysregulation or local mass effect. Whats the difference dysregulation is due to microadenomas (makes the pituitary secrete and unbalanced set of hormones), local mass effect is due to a macroadenoma (mass lesion – which interferes with function – ie ***panhypopituitarism, increased ICP, etc) this form of tumor is a result of a benign schwannoma acoustic neuroma ***what cranial nerve does the acoustic neuroma effect? cranial nerve VIII within the internal auditory canal what symptoms would you expect if you had an acoustic neuroma hearing loss, tinnitus, disequilibrium If a person had an acoustic neuroma, and symptoms were related to compression of the facial nerve or brainstem, what would this tell you its a larger neuroma and its most likely spread to ****the cerebellopontine angle metastatic tumors originate most often from primary sites in the ______. What other tumors spread to the brain? lung or breast; melanoma, hypernephroma, colon cancer ***These tumors tend to bleed more during resection metastatic tumors There is more than one tumor growing in the brain – what is the likely diagnosis metastatic tumor ***this broad category of tumor accounts for 2/3 of the tumors in children posterior fossa tumors most common posterior fossa tumors in children astrocytoma, medulloblastoma, brainstem gliomas most common posterior fossa tumors in adults acoustic neuromas, metastases, meningiomas What to worry about with posterior fossa tumors increased ICP & hydrocephalus, impaired airway reflexes and aspiration, irregular respiration due to brainstem compression, impaired LOC which category of tumors would raise concerns about the patient's breathing postoperatively posterior fossa tumors if the patient is going to have electrophysiologic monitoring – what would this effect for anesthesia anesthetic drug choices and the use of muscle relaxants What challenges are there with anesthesia in the tumor patient positioning issues, challenging variety (age and positioning), anesthetic drug choices may be different, may be done in an awake patient

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