Space occupying lesion Flashcards
List the signs of a space occupying lesion
Increased ICP - Headache worse on waking, lying down, bending forward or coughing, vomiting, Papilloedema, decreased GCS
Seizures - seen in <50%
Evoking focal neurology
Subtle personality change
Which types of seizures indicate a SOL cause
Adult onset seizures
Focal
Localizing aura
Post ictal weakness (Todds palsy)
Which sign results in false localising signs?
Increased ICP
What is the most common false localizing sign with increased ICP?
6th cranial nerve palsy - long intracranial course
Name some space occupying lesions
Tumour Aneurysm Abscess Chronic subdural haematoma Granuloma Cyst
Which cancers cause brain mets?
Breast
Lung
Myeloma
List some primary brain tumours
Astrocytoma Glioblastoma multiforme Oligodendroglioma Ependymoma Meningioma Primary CNS lymphoma Cerebellar hemangioblastoma
What investigations do you do for space occupying lesions?
CT/MRI
Biopsy
Avoid LP before imaging
Why should LP be avoided before imaging in SOL?
Risk of coning - cerebellar tonsils herniation through the foramen magnum
How do you treat benign space occupying lesions?
Remove asap if possible and accessible
How do you treat malignant space occupying lesions?
Excision of glioma is hard - unclear resection margins
Surgery gives tissue diagnosis and debulks pre-radiotherapy, makes cavity for inserting carmustine wafers into
If a tumour is inaccessible but causing hydrocephalus, what treatment is done?
ventriculo-peritoneal shunt
When is chemo/radiotherapy used for gliomas or metastases
Post op for gliomas or metastases
Sole therapy for inaccessible tumours
Which alkylating agent increases survival in glioblastoma?
Temozolomide
What drug is given to treat cerebral oedema in space occupying lesions
Dexamethasone 4mg/8h PO or Mannitol if Increased ICP acutely
Describe the prognosis of space occupying lesions
Poor but improving for CNS primaries
Benign tumours are curable by excision
What is a third ventricle colloid cyst
Congenital cyst declared in adulthood with amnesia, headache, obtundation (blunted consciousness), incontinence, dim vision, bilateral paraesthesia, weak legs and drop attacks
How are third ventricle colloid cysts treated?
Excision or ventriculo-peritoneal shunting
Give the localising features of a SOL in the temporal lobe
Dysphasia
Contralateral homonymous hemianopia
Amnesia
Many odd or seemingly inexplicable phenomena
Give the localising features of a SOL in the frontal lobe
Hemiparesis Personality change Release phenomena such as grasp reflex Brocas dysphasia Difficulty in initiating and planning speech with intact repetition and no anomia Unilateral anosmia Preservation Executive dysfunction Decreased verbal fluency
Give the localising features of a SOL in the parietal lobe
Hemisensory loss Decreased 2-point discrimination Asterogenesis Sensory inattention Dysphasia Gertsmanns syndrome
Give the localising features of a SOL in the occipital lobe
Contralateral visual field defects
Palinopsia (persisting images once stimulus has left field of view)
Polyopia (seeing multiple images)
Give the localising features of a SOL in the cerebellum
Dysdiadochokinesis/Dysmetria Ataxia Nystagmus Intention tremor Slurred/staccato speech Hypotonia
Give the localising features of a SOL in the cerebellopontine angle
Unilateral deafness Nystagmus Decreased corneal reflex Facial weakness Ipsilateral cerebellar signs Papilloedema 6th cranial nerve palsy
What lesions may be present on the cerebellopontine angle?
Acoustic neuroma, Vestibular schwannoma
What condition may someone have if presenting with symptoms of a SOL without one found on imaging?
Idiopathic intracranial hypertension
Describe the typical patient presenting with idiopathic intracranial hypertension
30yo
Obese
Female
What symptoms do patients with idiopathic intracranial hypertension present with
Narrow visual fields Blurred vision Diplopia 6th nerve palsy Enlarged blind spot Papilloedema Consciousness and cognition are preserved
What is idiopathic intracranial hypertension associated with?
Endocrine abnormalities - Cushing's syndrome, hypoparathyroidism, changes in TSH levels) SLE CKD IDA PRV
What drugs are associated with idiopathic intracranial hypertension
tetracyclines, steroids, nitrofurantoin, oral contraceptives
Describe the management of idiopathic intracranial hypertension
Weight loss Acetazolamide or topiramate Loop diuretics Prednisolone Consider optic nerve sheath fenestration or lumbar peritoneal shunt if drugs fail and visual loss worsens
What is the prognosis of idiopathic intracranial hypertension
Often self limiting
Permanent significant visual loss in 10%
