Space-Occupying Lesions

Question 1

What is this a presentation of?
Headache worse on lying down/bending forward/coughing, vomiting, papilloedema, low GCS, seizures, focal neuropathy, personality change.

Answer 1

Space-occupying lesion (headaches rarely a feature in brain tumours)

Question 2

What are the causes of a space-occupying lesion?

Answer 2

1. Primary tumour (astrocytoma, glioblastoma, meningioma)
2. Metastatic tumour 30% (breast, lung, melanoma)
3. Aneurysm, abscess, haematoma, granuloma, cyst

Question 3

What are the differentials for a space-occupying lesion?

Answer 3

Stroke, head injury, vasculitis, MS, metabolic, post-ictal.

Question 4

How is a space-occupying lesion investigated?

Answer 4

1. CT/MRI
2. Consider biopsy
3. Avoid LP before imaging (risk of coning)

Question 5

What is the management for a space-occupying lesion?

Answer 5

1. Benign - remove surgically
2. Malignant - excision, de-bulking radiotherapy
3. Cerebral oedema - dexamethasone, mannitol if acute

Question 6

Where would a space-occupying lesion be if these features were present?
Contralateral homonymous hemianopia/upper quadrantinopia, amnesia, Wernicke’s aphasia.

Answer 6

Temporal lobe

Question 7

Where would a space-occupying lesion be if these features were present?
Hemiparesis, personality change, executive dysfunction (unable to plan), Broca’s aphasia.

Answer 7

Frontal lobe

Question 8

Where would a space-occupying lesion be if these features were present?
Hemisensory loss, stereognosis, sensory inattention, inferior homonymous quadrantinopia.

Answer 8

Parietal lobe

Question 9

Where would a space-occupying lesion be if these features were present?
Contralateral visual field defects.

Answer 9

Occipital lobe

Question 10

Where would a space-occupying lesion be if these features were present?
Dysdiadochokinesia, ataxia, nystagmus, intention tremor, past-pointing, slurred speech, hypotonia.

Answer 10

Cerebellum