Space Occupying Lesions

Question 1

Presentation

Answer 1

Focal deficits
Seizures
Symptoms of raised ICP
-headache
-papillodema
-vomiting
-Cushings triad (bradycardia, widening pulse pressure, irregular breathing)

Question 2

Possible differentials

Answer 2

Hydrocephalus
Trauma
Tumours
Vascular causes

Question 3

Hydrocephalus

-types

Answer 3

Communicating (post haemorrhagic, post infection)

Obstructive (flow of CSF impeded)

Question 4

Hydrocephalus

-presentation in neonates, young children

Answer 4

Increasing head circumference
Full, tense fontanelle with dilated scalp veins

Loss of upgaze

Irritability
Vomiting
Drowsiness
Reduced consciousness

Question 5

Hydrocephalus

-presentation in older children and adults

Answer 5

Headache
N+V
Visual deficit
Loss of upgaze
Drowzy
Reduced consciousness

Question 6

Hydrocephalus

-investigations

Answer 6

US in neonates - fontanelle open

CT, MRI => detect CSF flow
Volumetric scan

Question 7

Hydrocephalus management

• temporary
• definitive

Answer 7

Temporary

• ext ventricular drain
• ventriculosubgaleal shunt
• drain into resevoir under scalp

Definitive

• ventriculoperitoneal/ventriculoatrial/ventriculopleural shunt
• ext 3rd ventriculostomy
• fenestrations, stents

Question 8

EDH

SDH

Answer 8

EDH - Above dura
MMA at pterion

SDH - Below dura
Tearing of bridging veins

Question 9

Management of contusions and diffuse axonal injury

-what is the difference

Answer 9

Contusions - Traumatic intracerebral hematoma
-if large and causing mass effect => evacuation of hematoma

Diffuse axonal injury

• many small contusions
• if ICP increases => ICP monitoring to decide on surgical ntervention

Question 10

Which tumours are most common in

• adults
• children

Answer 10

Adults - MOST COMMON mets
-GBM, AA, LGG, meningioma

Children - most common solid tumour, 2nd most common to leukemia
-most commonly found infratentorially

Question 11

Tumour

• diagnosis
• initial management of symptoms
• definitive management

Answer 11

CT diagnosis
-MRI, CTCAP - assess if 1ary or 2ndary

Initial management of SOL symptoms

• steroids => reduce swelling
• gastric protection needed from steroid SE
• antiepileptics if needed

Refer to neurosurgery
-generally resected

Question 12

Management of

• severe ischemic stroke
• spontaneous intracerebral hematoma
• SAH
• AVM
• cavernoma

Answer 12

Ischemic stroke
-Requires neurosurgery decompression if swelling is a threat to life

Spontaneous intracerebral hematoma - hemorrhagic stroke often due to HTN
-surgical evacuation considered

SAH - sudden severe headache cause mainly by trauma or aneurysms
-endovascular coils, clips, nimodipine

AVM - present with either hemorrhage/seizure

• resection
• stereotactic radiosurgery

Cavernoma - present with bleeds, seizures

• abnormal collection of vessels
• depends on severity