Oncological Presentations - Space Occupying Lesions Flashcards
Presentation
New headache with features of raised ICP
- papillodema
- vomiting
- posture related headache
- headache waking patient from sleep
Unexplained severe headache
Especially in those diagnosed with past cancer/HIV
Neurological symptoms
- seizure
- confusion
- personality/memory change
- blackout
- ataxia
Investigations
Routine bloods
-low Na = SIADH
Imaging
-CT head with contrast
What would you do to differentiate between primary and secondary brain tumours
If mets = from lung, breast, colon, melanoma, testicular
- reassess for scars, melanoma, testicular masses
- CXR
- CT CAP
- MRI head with gadolinium
Brain tumours do not normally mets
- most likely - astrocytoma
- menigioma
Differential diagnoses
Malignancy
- primary - glioma, meningioma, schwannoma, pituitary, PNET
- secondary - brain mets
Trauma
-subdural, extradural hematoma
Infection
- TB granuloma
- abscess
Vascular
-aneurysm, AVM, CVA
Cysts
Pathophysiology of SOL
Increased ICP - mass effect, CSF obstruction
- headaches, N+V
- behaviour changes
Cerebral irritation
-seizures
Interruption of pathways (vascular supply interrupted)
-focal neuro deficit
Management
Dexamethasone
-not needed if small with no edema, asymptomatic
Monitor BG (brain tumours affect BG control)
- antiemetic, analgesia
- antiepileptics for seizures
Supportive
RT, CT, combination
Surgery
