Space Occupying Lesions

Question 1

What is the Clinical Presentation of Space Occupying Lesions?

Answer 1

• Seizures (aura before, disturbed taste and smell - temporal lobe affected
• Focal Neurology anf Gait Disturbance
  -Raised Intercranial Pressure
• Neuropsychiatric effects
• Endrocrine Abnormalities
• Incidental findings on imaging

Question 2

What does the clinical presentation depend on?

Answer 2

• The place of the SOL

Question 3

Is raised ICP common?

Answer 3

• No it is a rare sign

Question 4

Is Seizures common?

Answer 4

• Yes, typically seen in a SOL

Question 5

How does ICP present?

Answer 5

• Headaches
• Vomiting
• Papilloedema

Question 6

How does Neuropsychiatric effects present?

Answer 6

• Personality changes
• Mental State
• Memory and Cognition

Question 7

Where does the SOL typically have to be to see a personality change?

Answer 7

• Frontal Tumours

Question 8

What Imaging Investigations are done for a SOL?

Answer 8

• CT +/- contrast ( contrast helps identify a tumour as it helps visualise the vessels/ vasculature better)
• MRI
• Diffusion Weighted MRI

Question 9

What is the Gold Standard Investigation for areas of Ischaemic Stroke?

Answer 9

• Diffusion Weighted MRI

Question 10

What Investigations can be used in Specialist Neurology Centres to help differentiate between Brain Tumours?

Answer 10

• MR spectroscopy ( to assess metabolism)
• MR perfusion ( to assess vascularity)

Question 11

How would you describe MRI/CT imaging ? (Pneumonic)

Answer 11

• Particularly
• Interesting
• Surgeons
• Love
• Carefully
• Drilling
• Massive
• Burr
• Holes

Question 12

How would you describe MRI/CT imaging?

Answer 12

• Patient and Imaging Technique Details
• Intra OR Extra Axial (inside or outside of the brain parenchyma)
• Shape
• Location
  (Supra OR Infratentorial) // (Lobes/ parts of the brain involved)
• Density OR Intensity (Hypo/hyperdense used with CT) // (Hypo/hyperintense used with MRI)
• Border
  (How Defined // Oedema)
• Contrast Enhancement
  ( Homogenous/Heterogenous) //
  (Rim enhancement - absesses)
• Mass Effect
  (Effacement of Sulci: ipsilateral/ contralateral)
  (Midline Shift)
  (Ventricle Compression)
  (Basal Cisterns: Obliterated/ Patent - indicated raised ICP)
• Hydrocephalus

Question 13

What are the Differential Diagnosis for SOL?

Answer 13

• Vascular (Haemorrhage, Infarct, Vascular Malformation, Aneurysm)
• Infection (Abscess)
• Neoplastic (Metastasis, Primary Brain Tumour)
• Cyst
• Inflammatory (Multiple Sclerosis, Granulomatous disease)