Neurology

1.

Neurology
INTRACRANIAL TUMOURS & DEMENTIA

2.

Memory loss
Dementia
Amnesia
Delirium
Memory loss
Cognitive impairment
or memory loss
Cognitive impairment
or memory loss
Onset: insidious
Onset: rapid
Duration: irreversible
Duration: reversible
Chronic
Permanent
Waxes and wanes over
time

3.

4.

Alzheimer’s
disease

5.

Alzheimer’s disease

6.

Alzheimer’s disease

7.

Alzheimer’s disease
Sporadic and Familial (PSEN-1 or PSEN2 mutation and trisomy 21)
Symptoms: short-term memory loss->
loss of motor skills and language->
long-term memory loss-> more
disoriented-> bedridden->death
Diagnosis: clinical, brain biopsy,
CT (cortical atrophy)
Treatment: no cure, supportive care,
family education.
Cholinesterase inhibitors: Tacrine,
Donepezil, Rivastigmine, Galantamine

8.

Pick’s disease

9.

Pick’s disease
Frontotemporal degeneration
Behavior and personality
change goes first (remain
memory)
Then dementia, aphasia,
parkinsonian aspects
Diagnosis: Clinical, CTfrontotemporal degeneration
Treatment: supportive

10.

Lewy-body
dementia

11.

Lewy-Body dementia
Early symptoms: difficulty focusing, poor memory,
visual hallucination, disorganized speech and
depression
Later symptoms: resting tremor, stiff and slow
movements, reduced facial expression
Sleep disorders
Diagnosis: clinical, biopsy
Treatment: cognitive sym. – donepezil, motor sym.
- levodopa

12.

Vascular
dementia

13.

Vascular dementia
Multi-infarct dementia
Symptoms:
Very depend on which region of the
brain is damage
Stepwise decline
Diagnosis: Clinical, neuropsychological
test, CT or MRI
Treatment: reducing rick of repeated
strokes

14.

CJD

15.

CJD
Caused by prions
From sporadic mutation, abnormal
gene, uncooked meat
30-40s ages
Symptoms: sleep disorders, visual
deterioration, loss of coordination,
cognitive impairment, personality
change
Diagnosis: clinical
Treatment: supportive

16.

Normal Pressure
Hydrocephalus

17.

Normal Pressure Hydrocephalus
Due to increased ICP
Symptoms: urinary incontinence,
ataxia, dementia
Diagnosis: CT – hydrocephalus
LP – get improvement of condition
Treatment: VP shunt

18.

Huntington’s
disease

19.

Huntington’s disease
Inherited disorder
Uncontrolled movement – chorea,
unsteadiness, clumsiness, loss of
balance, slurred speech, trouble
swallowing and eating
Diagnosis: clinical (chorea + abnormal
behavior + dementia + family)
Treatment: supportive

20.

Intracranial
tumors

21.

Brain cancer
Primary 30%(singular) and secondary 70%(multiple lesions)
Symptoms: focal neurologic deficit, seizure, headache worse in the
morning
Diagnosis: MRI with contrast, CT, biopsy
Treatment: resection, radiation or/and chemo, steroids, seizure profilaxis

22.

Glioblastoma Multiforme
Adults
Highly malignant tumor
Product of parenchyma and tends to
cross the corpus callosum
Ring-enhancing lesion or Bat’s wing
deformation

23.

Oligodendroglioma
Adult
forms from oligodendrocytes
can occur in the brain or spinal cord
Histology: chicken wire capillary
pattern, ”fried egg” cell, calcified
tumor

24.

Meningioma
Adult
Benign, superficially located
Product of Dura
Histology: psammoma bodies, spindle
cells
Treatment: resection and curative

25.

Hemangioblastoma
Adult
Blood vessel origin
EPO producing
Histology- thin walled capillaries

26.

Pituitary gland

27.

Pituitary Adenoma
Prolactinoma
Acromegaly
Cushing disease
Premenopausal females:
Hypogonadism,
oligomenorrhea or
amenorrhea, galactorrhea
Kids: gigantism
Mood face, buffalo hump, truncal
obesity
Males:
Decrease libido, impotence,
infertility
Dx: prolactin, MRI
Tx: Cabergoline
Adults: acromegaly hands,
feet, face and visceral
organs, diabetes and
diastolic heart failure
Dx: IGF1 glucose suppression
test
Tx: surgery, Octreotide,
Debulking or radiotherapy
Dx: ACTH
Tx: surgery, radiation therapy,
Metyrapone

28.

Acromegaly

29.

Non- functional pituitary adenoma
Usually macroadenomas
Compression symptoms: headache
&visual impairment
Bitemporal hemianopia
Double vision
Diagnosis: MRI, visual field testing

30.

Schwannoma
Adult
Occur at the
cerebellopontine
angle
Damage of CN7 &
CN8
Histology: S-100+

31.

Childhood tumors
Infratentorial tumors
Pilocytic Astrocytoma
Craniopharyngioma
From Astrocytes
From remnants of Rathke’s pouch
Rosenthal Fibers
Above the sella turcica
pituitary gland
Medulloblastoma
Supratentorial tumors
From embryonic stem cells and primitive
neuroendocrine cells
Homer-Wright rosettes
Ependymoma
compress the
Pinealoma
From pinocytes or germ cells
Parinaud syndrome
From neuroglial cells
Paralysis of upward gaze
Perivascular pseudorosettes
Pupillary light-near dissociation
Convergent-retraction nystagmus

32.

Childhood tumors