Space-occupying lesion

Question 1

Signs - Raised ICP:

Main symptom? 
What makes it worse?- 4
Other symptoms:
- GI
- Eyes

Answer 1

Headache

Worse on waking
Lying down
Bending forward
Coughing

Vomiting
Papilloedema

Question 2

Signs:

Subtle personality changes - how might this present?

Other signs of space-occupying lesions?

Answer 2

Irritability
Lack of application to tasks
Lack of initiative
Socially inappropriate behaviour

Seizures
Evolving focal neurology

Question 3

Causes:

Answer 3

Tumour 
Aneurysm 
Abscess 
Chronic subdural haematoma 
Granuloma - Sarcoidosis 
Cyst

Question 4

Investigations?

Why should LP be avoided before imaging?

Answer 4

CT+/-MRI

Risk of coning

Question 5

Tumour management:

What if benign?

Malignant:

• Why is the excision of gliomas hard?
• What can be put in for local chemotherapy?
• What can be done if a tumour is inaccessible but it is causing hydrocephalus?

Answer 5

Remove if possible

A carmustine wafers - Gliadel is a wafer that contains the chemotherapy drug carmustine. Your brain surgeon (neurosurgeon) puts the wafer in during surgery to remove the brain tumour. It is a treatment for a brain tumour called glioblastoma multiforme (glioma) in adults.

Ventriculoperitoneal shunt

Question 6

What drug can be given for cerebral oedema?

What can be given for raised ICP acutely? - M

Answer 6

Dexamethasone

Mannitol

Question 7

Localising features:

Temporal lobe features?

Answer 7

Dysphasia
Contralateral homonymous hemianopia
Upper quadrantanopia if only Meyer’s loop affected
Amnesia
Mant odd or seemingly inexplicable phenomena

Question 8

Localising features:

Frontal lobe features?

Answer 8

Hemiparesis 
Personality change 
Broca's dysphasia 
Difficulty initiating and planing speech 
Unilateral anosmia (loss of smell) 
Executive dysfunction

Question 9

Localising features:

Parietal lobe features?

Answer 9

Hemisensory loss 
Lack of 2 point discrimination 
Sensory inattention 
Dysphasia 
Asteregnosis - unable to recognise an object

Question 10

Localising features:

Occipital lobe features?

Answer 10

Contralateral visual field defects

Question 11

Localising features:

Cerebellar features - Mneumonic - DANISH

Answer 11

Dysdiadochokinesis (impaired rapidly alternating movements)
&
Dysmetria (past-pointing)

Ataxia - limb/truncal - lack of voluntary coordination of muscle movements that can include gait abnormality, speech changes, and abnormalities in eye movements.

Nystagmus

Intention tremor

Slurred speech (dysarthria)

Hypotonia