Suspected Space Occupying Lesion

Question 1

What are the signs and symptoms of a potential SOL?

Answer 1

1. Headache
2. N&V
3. Vision changes
4. Speech changes
5. Limb weakness
6. Confusion
7. Seizure

Question 2

How would I approach a patient with a potential SOL?

Answer 2

1. A-E assessment (CBG)
2. History (+/- collateral(
3. Focussed cancer history
   - type
   - treatment (SACT/radio/immuno/
   - prognosis
4. ICE

Question 3

What investigations would I want to do for a patient with a potential SOL?

Answer 3

1. Bloods including Calcium, Sodium
2. CT head initially
3. MRI gold standard

Question 4

How would I manage a patient with a confirmed space occupying lesion?

Answer 4

1. Dexamethasone 16mg + PPI
2. Urgent neurosurgery if low GCS, midline shift, mass effect
3. Speak to ICU
4. Referral for neurosurgery MDT
5. Inform parent team or AO, if not known diagnosis will need staging CT scan