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Neurology finals > Space occupying lesion > Flashcards

Space occupying lesion Flashcards

1
Q

List the signs of a space occupying lesion

A

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

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2
Q

Which types of seizures indicate a SOL cause

A

Adult onset seizures
Focal
Localizing aura
Post ictal weakness (Todds palsy)

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3
Q

Which sign results in false localising signs?

A

Increased ICP

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4
Q

What is the most common false localizing sign with increased ICP?

A

6th cranial nerve palsy - long intracranial course

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5
Q

Name some space occupying lesions

A 
Tumour
Aneurysm 
Abscess
Chronic subdural haematoma 
Granuloma
Cyst
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6
Q

Which cancers cause brain mets?

A

Breast
Lung
Myeloma

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7
Q

List some primary brain tumours

A 
Astrocytoma
Glioblastoma multiforme
Oligodendroglioma
Ependymoma
Meningioma
Primary CNS lymphoma
Cerebellar hemangioblastoma
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8
Q

What investigations do you do for space occupying lesions?

A

CT/MRI
Biopsy
Avoid LP before imaging

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9
Q

Why should LP be avoided before imaging in SOL?

A

Risk of coning - cerebellar tonsils herniation through the foramen magnum

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10
Q

How do you treat benign space occupying lesions?

A

Remove asap if possible and accessible

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11
Q

How do you treat malignant space occupying lesions?

A

Excision of glioma is hard - unclear resection margins

Surgery gives tissue diagnosis and debulks pre-radiotherapy, makes cavity for inserting carmustine wafers into

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12
Q

If a tumour is inaccessible but causing hydrocephalus, what treatment is done?

A

ventriculo-peritoneal shunt

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13
Q

When is chemo/radiotherapy used for gliomas or metastases

A

Post op for gliomas or metastases

Sole therapy for inaccessible tumours

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14
Q

Which alkylating agent increases survival in glioblastoma?

A

Temozolomide

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15
Q

What drug is given to treat cerebral oedema in space occupying lesions

A

Dexamethasone 4mg/8h PO or Mannitol if Increased ICP acutely

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16
Q

Describe the prognosis of space occupying lesions

A

Poor but improving for CNS primaries

Benign tumours are curable by excision

17
Q

What is a third ventricle colloid cyst

A

Congenital cyst declared in adulthood with amnesia, headache, obtundation (blunted consciousness), incontinence, dim vision, bilateral paraesthesia, weak legs and drop attacks

18
Q

How are third ventricle colloid cysts treated?

A

Excision or ventriculo-peritoneal shunting

19
Q

Give the localising features of a SOL in the temporal lobe

A

Dysphasia
Contralateral homonymous hemianopia
Amnesia
Many odd or seemingly inexplicable phenomena

20
Q

Give the localising features of a SOL in the frontal lobe

A 
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
21
Q

Give the localising features of a SOL in the parietal lobe

A 
Hemisensory loss
Decreased 2-point discrimination
Asterogenesis
Sensory inattention 
Dysphasia
Gertsmanns syndrome
22
Q

Give the localising features of a SOL in the occipital lobe

A

Contralateral visual field defects
Palinopsia (persisting images once stimulus has left field of view)
Polyopia (seeing multiple images)

23
Q

Give the localising features of a SOL in the cerebellum

A 
Dysdiadochokinesis/Dysmetria
Ataxia
Nystagmus
Intention tremor
Slurred/staccato speech 
Hypotonia
24
Q

Give the localising features of a SOL in the cerebellopontine angle

A 
Unilateral deafness
Nystagmus
Decreased corneal reflex 
Facial weakness
Ipsilateral cerebellar signs 
Papilloedema 
6th cranial nerve palsy
25
Q

What lesions may be present on the cerebellopontine angle?

A

Acoustic neuroma, Vestibular schwannoma

26
Q

What condition may someone have if presenting with symptoms of a SOL without one found on imaging?

A

Idiopathic intracranial hypertension

27
Q

Describe the typical patient presenting with idiopathic intracranial hypertension

A

30yo
Obese
Female

28
Q

What symptoms do patients with idiopathic intracranial hypertension present with

A 
Narrow visual fields
Blurred vision 
Diplopia
6th nerve palsy 
Enlarged blind spot 
Papilloedema
Consciousness and cognition are preserved
29
Q

What is idiopathic intracranial hypertension associated with?

A 
Endocrine abnormalities - Cushing's syndrome, hypoparathyroidism, changes in TSH levels) 
SLE
CKD
IDA
PRV
30
Q

What drugs are associated with idiopathic intracranial hypertension

A

tetracyclines, steroids, nitrofurantoin, oral contraceptives

31
Q

Describe the management of idiopathic intracranial hypertension

A 
Weight loss
Acetazolamide or topiramate 
Loop diuretics 
Prednisolone 
Consider optic nerve sheath fenestration or lumbar peritoneal shunt if drugs fail and visual loss worsens
32
Q

What is the prognosis of idiopathic intracranial hypertension

A

Often self limiting

Permanent significant visual loss in 10%

Neurology finals (32 decks)

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