Space occupying lesion

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aditya Govindavarjhulla, M.B.B.S. [2]

Overview

Intracranial space occupying lesions are tumors or abscesses present within the cranium or skull. These lesions put pressure on the adjacent brain tissue causing its damage.

Pathophysiology

• Tumors of brain may develop focally or can be of metastatic origin. They grow in size causing focal tissue damage by pressure and infiltration.

• Bleeding into the brain tissue causes formation of hematoma. If these hematoma's get infected they may turn into abscess

Causes

• primary brain tumors
• Metastatic lesion
• Hematoma
• Cerebral abscess
• Lymphomas
• Granuloma
• Tuberculoma
• Cysticercosis

Risk factors

• Trauma
• HIV infection
• Diabetes
• Malignancy
• COPD( Chronic obstructive pulmonary disease)
• Tuberculosis

History and symptoms

• Headache
• Nausea
• Vomiting
• Change in mental status
• Seizures
• Focal symptoms of brain damage
• Associated co-morbid conditions like tuberculosis, etc

Diagnosis

Blood tests

• Total blood count, hemoglobin levels for general condition of the person.
• Electrolyte levels
• Serum BNP(Brain natriuretic peptide)

Biopsy

• Biopsy of the lesion is needed to know the nature of the lesion.

X ray

• X- ray skull is quite a non specific test, but useful if any of the lesions are calcified.

• X- ray chest may be warranted if any metastatic tumor is suspected.

CT and MRI

• These tests are of higher value to detect intracranial lesions.
• They have higher sensitivity and specificity compared to X-rays.

Treatment

Treatment depends on the type of the lesion and associated co morbid conditions. Medical therapy

• Pain killers to relieve the person from headache.
• Steroids to reduce cerebral edema.
• Mannitol to reduce intra cranial pressure.
• Anticonvulsant medication to cover seizures.
• Infections will need antibiotics which can cross blood brain barrier.
• Tumors will treated with chemotherapy.

Surgery

• Primary brain tumors can be surgical excised if they are amendable to surgery.
• Brain radiation is useful in radio sensitive tumors.
• Hematomas are surgically evacuated.