space occupying lesions Flashcards
describe clinical presentations of space-occupying lesions
seizures
headaches -raised icp
incidental finding following minor trauma
gait disturbance + focal neurology
neuropsychiatric effects - change in personality, memory and cognition
endocrine abnormalities - pituitary gland
sx of raised icp
headache - wakes pt from sleep, worse with coughing
vomiting
papilloedema
which lobe lesion associated most commonly with seizures and what auras are seen
temporal lobe
seizures with aura preceding it - change in taste or smell
neuropsychiatric features are common with types of lesions where
frontal lobe - personality changes, memory and cognition
describe imaging/investigations used in space-occupying lesions
CT scan with or without contrast
MRI usually with contrast
diffusion weighted MRI
what is contrast
areas of vascularity are more prominent (useful if a tumour or infection suspected)
what multi-modal MRIs are used in specialist neuroscience and what do they assess
MR spectroscopy to assess metabolism
MR perfusion to assess vascularity
what are the steps to describe MRI/CT scan?
PARTICULARLY INTERESTING SURGEONS LOVE CAREFULLY DRILLING MASSIVE BURR HOLES
- patient and imaging technique details
- intra axial or extra axial
- shape
- location - supra or infratentorial, lobes or parts of brain involved
- density in CT or intensity in MRI = hypo/hyperdense vs hypo/hyperintense in MRI
- border = how well defined, oedema
- contrast enhancement = homogenous/heterogenous, rim enhancement (e.g: cyst)
- mass effect = effacement of sulci (ipsilateral or contralateral), midline shift, ventricle compression, basal cisterns - obliterated or patent
- hydrocephalus
what eGFR is required for contrast to be used
30 or more
what are the differential diagnosis for intracranial mass lesions
- vascular - haemorrhage, infarct, vascular malformation, aneurysm
- infection - abscess
- neoplastic - metastasis, primary brain tumours
- cyst
- inflammatory - MS, granulomatous disease
