Patho- SPace occupying lesions Flashcards
What things can cause a space occupying lesion?
Bleeds
Tumour
Idiopathic intracranial hypertension
Hydrocephalus
What types of bleed can cause a space occupying lesion?
Extradural
Subdural
SAH
What can cause an extradural hematoma?
Trauma
What can cause a subdural hematoma?
Ruptured bridging vein
What can cause a SAH?
CoW rupture/Berry aneurysm
What is the most common brain tumour?
Secondary mets
What are the most common mets to the brain?
Breast
Bronchus
Malignant melenoma
What are the two categories of primary brain tumour?
Extrinsic- Meninges
Intrinsic- Brain parenchyma
Give an example of extrinsic brain tumours?
Meningioma
From where does a meningioma normally occur?
Subarachnoid
What are some symptoms of a meningioma?
Largely asymptomatic
Headache
CN neuropathy
Can erode bone
How do you treat a meningioma?
CT/MRI- Homogenous, space-occupying lesion that densely enhances after contrast media
Leave
Surgery
Radio
What is the most common form of intrinsic brain tumour?
Glioma
What kind of cells do glioma arise from?
Glial cells
Can gliomas metastase?
Yes but only to the brain
What glial cells do gliomas tend to arise from?
Astrocytes
Oligoendrocytes
What are the symptoms of an oligodendrocyte glioma?
Slow growing Solid pink/grey Frontal lobe 25-45YO Seizures Can become malignant Calcifications
How do you treat an oligodendrocyte glioma?
Surgery and chemo
What are the four grades of an astrocytoma?
I- Benign
II- Start benign then transform
III/IV- Malignant then die in months
What is an example of a grade I astrocytoma?
Pilocytic astrocytoma
What is a Pilocytic astrocytoma?
Grade I astrocytoma
Where do Pilocytic astrocytoma normally affect?
Optic nerve
Brain stem
Cerebellum
Give some examples of a grade II astrocytoma?
‘Low grade’ astrocytoma- Seizures
Fibrillary Astrocytoma- Surgery
Astrocytomas become Glioblastoma- Surgery
Give some examples of a stage III/IV astrocytoma
Anaplastic Astrocytoma
Glioblastoma multiforme
How do you treat an Anaplastic Astrocytoma?
No cure but surgery can help- radio post op
How do you treat Glioblastoma multiforme?
No cure but surgery can help- radio post op
How do gliomas tend to present?
Insidious onset of neuro deficits
Seizures
What is the differential for a glioma?
Stroke
How do you treat a glioma?
Image
Pallitate
What are some examples of nerve sheath tumour?
Schwannoma
Neurofibroma
What is the most common schwannoma?
Vestibular schwannoma
What are the symptoms of a vestibular schwannoma?
Progressive deafness
Facial sensory loss
Ipsilateral cerebral sign
Hydrocephalus
How do you treat a vestibular schwannoma?
Hydrocephalus treatment
Radio
Surgery
How do you diagnose a schwannoma?
MRI
What are the general symptoms of a brain tumour?
Progressive neuro deficit Motor weakness Headache- wakes them up New seizures Changes in behavior Symptoms of increased ICP: N+V, Headache, Mental changes, Seizures
What are the direct effects of a brain mass?
Tissue destruction
What are the secondary effects of a brain mass?
Herniation
Raised ICP effects- papilloedema etc
What causes the secondary effects of a brain mass?
Raised ICP
What are some raised ICP effects?
Papilloedema
Non-communicating hydrocephalus
What are the forms of herniation possible in the brain?
Subfalcine/cingulate- cross midline
Transtentorial/uncal herniation- Cerebral through tentorium
Tonsillar- coning. Cerebellum down through foramen magnum.
What are some signs of tonsillar herniation?
Impaired consciousness
Resp arrest
Bradycardia
Decerebrate posture- Arms and legs being held straight out, the toes being pointed downward and the head and neck being arched backwards.
How do you treat a brain mass?
No LP Mannitol + steroids- for oedema Antiepileptics Chemo not much help Surgery can help but is complicated
What must you not do with raised ICP?
LP
Why must you not LP a raised ICP?
Coning risk
What is Idiopathic intracranial hypertension?
Hydrocephalus with no mass and no increase in ventricle size
Who tends to get Idiopathic intracranial hypertension?
Obese young women
WHat are some symptoms of Idiopathic intracranial hypertension?
Menstral irregularities
Headache
Blurred vision
Papilloedema
How do you treat idiopathic intracranial hypertension?
Repeated LP
Acetazolamide
Thiazide diuretics
Weight reduction
What generally causes hydrocephalus?
Obstruction of outflow leading to enlargement of ventricle
WHat are the main causes of hydrocephalus in infants?
Arnold-Chiari malformation
Cerebral aqueduct stenosis
What is the main cause of hydrocephalus in adults?
Cerebral aqueduct stenosis
What are some symptoms of hydrocephalus in adults?
Headache Cogitative impairment Vomiting Papilloedema Ataxia Bilateral signal
How do you treat hydrocephalus in adults?
Treat underlying cause
Shunt
