Space Occupying Lesions Flashcards
What are causes of space occupying lesions (SOL)?
Tumours Haematoma Aneurysms Abscess Granuloma Cysts
What is the presentation of a SOL?
Raised ICP - headache worse in the morning and with coughing or leaning forward, vomiting
Seizures
Progressive focal neurological signs
What neurological signs are caused by a SOL in the frontal lobe?
Weakness Expressive dysphagia Loss of smell Personality change Loss of motivation Social disinhibition Reduced executive functioning
What neurological signs are caused by a SOL in the temporal lobe?
Reduced memory Reduced hearing Receptive dysphagia Emotional disturbance Odd phenomena - déjà vu Reduced abstract thinking Contralateral homonymous hemianopia
What neurological signs are caused by a SOL in the parietal lobe?
Sensory loss
Reduced 2 point discrimination
Reduced ability to recognise by touch
What neurological signs are caused by a SOL in the occipital lobe?
Contralateral vision loss
Visual disturbance
What neurological signs are caused by a SOL in the cerebellum?
Ataxia Nystagmus Slurred speech Reduced dysdiadokokinesis Intention tremor/past pointing Wide based gait Reduced tone and reflexes
What neurological signs are caused by a SOL in the cerebellopontine angle?
Sensorineural hearing loss
Facial weakness
Tinnitus
Where is the SOL likely to be if the patient presents with
memory loss, difficulty understanding language and emotional disturbance?
Temporal lobe
Where is the SOL likely to be if the patient presents with slurred speech, wide based gait, intention tremor and reduced tone?
Cerebellum
Where is the SOL likely to be if the patient presents with left sided loss of vision?
Occipital (right side)
Where is the SOL likely to be if the patient presents with change to their personality, social disinhibition, difficulty with planning and concrete thinking, and difficulty expressing what they want to say.
Frontal lobe
Where is the SOL likely to be if the patient presents with loss of sensation and reduced 2 point discrimination?
Parietal
Where is the SOL likely to be if the patient presents with sensorineural hearing loss, tinnitus and facial weakness?
Cerebellopontine angle
True or false - brain tumours are the 2nd most common cause of cancer related death in <40s and the second most common type of tumour in children
They are the 1st (not 2nd) most common cause of cancer related death in <40s
They are the second most common type of tumour in children
What is the presentation of brain tumours?
Headache +/- raised ICP symptoms
Progressive focal neurological symptoms (most commonly weakness)
Seizures
What are the 5 most common types of primary brain tumour?
Astrocytoma Oligodendroglioma Medulloblastoma Meningioma Acoustic neuroma
What is the most common type of primary brain tumour?
Astrocytoma
Describe the 4 grades of astrocytoma?
Grade 1 - benign, commonly in children and young adults, slow growing, surgery is curative, good prognosis
Grade 2 - largely benign but have small malignant potential, usually in temporal or frontal lobes, average survival 4 years
Grade 3 - anapaestic astrocytoma, survival 2 years
Grade 4 - glioblastoma multiforme, highly invasive, occur from less malignant precursor or de novo, survival less than 1 year
What is the most common grade of astrocytoma?
Glioblastoma multiform - grade 4
What is an oligodendroblastoma?
Arise from oligodendrocyte glial cells
Develop in frontal lobe
Commonly invaded into subarachnoid space (toothpaste morphology)
Glow slowly over several decades
What age is the peak incidence of oligodendroblstoma?
Peak incidence 6-12 then again 25-45
How do oligodendrocytes most commonly present?
Seizures
What is the treatment for oligodendrocytes?
Highly chemo-sensitive
What are medulloblastomas?
Malignant tumours of the cerebellum
Form drop metastases down the spinal cord
Crumbly chalk-like appearance
Who generally present with medulloblastomas?
Almost exclusively children
How do medulloblastomas present?
Cerebellar signs
Raised ICP
What are meningiomas?
Extra-axial tumours of the arachnoid cap cells
Benign or malignant (majority slow growing and benign)
What is the presentation of meningiomas?
Focal neurological symptoms slowly developing as compression occurs due to growing tumour
What is seen on imaging in meningiomas?
Skull blistering often present
What are acoustic neuromas?
Nerve sheath tumour of the vestibulocochlear nerve
Tumour of Schwann cells
Where do acoustic neuromas develop?
Cerebellopontine angle
What are bilateral acoustic neuromas associated with?
Neurofibromatosis type 2
What is the presentation of acoustic neuromas?
Hearing loss
Tinnitus
Balance problems
Associated with facial nerve palsy
Are primary or secondary brain tumours more common?
Secondary
What are the types of tumour that commonly metastasise to the brain?
Lung Breast Kidney Colon Melanoma
What investigation is done for brain tumours?
MRI first line
Imaging for metastases (e.g. CXR)
Stereotaxic biopsy via skull burr hole
What is the general medical management for brain tumours?
VP shunt for hydrocephalus Analgesia for headache Seizure prophylaxis - phenytoin Acutely raised ICP- mannitol Prevention of raised ICP - dexamethasone
What is the tumour management for brain tumours?
Watchful waiting of benign
Surgical removal +/- radiotherapy or chemotherapy
Glioblastomas - temozolamide
Oligodendrogliomas are chemo-sensitive
