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intracranial mass lesion
Etiology:
- brain metastasis
- brain abscess
- primary brain neoplasm
- glioblastoma multiforme
- meningioma
- primary CNS lymphoma
- infectious
- toxoplasmosis
- cysticercosis
Clinical manifestations:
- seizures
- increased intracranial pressure
- ataxia
- focal neurologic deficits
Special laboratory:
- lumbar puncture if no significant shift of midline structures or mass effect on surrounding structures*
- stereotactic brain biopsy or aspiration of lesion
- brain abscess, toxoplasmosis, glioblastoma multiforme
* rim of edema & effacement of overlying cortical structures not a contraindication for lumbar puncture
Radiology:
- neuroimaging
- magnetic resonance imaging with gadolinium contrast
- prior urgent administration of glucocorticoids can alter gadolinium contrast enhancement & diminish sensitivity of brain biopsy for primary CNS lymphoma
Management:
- a growing mass lesion within a confined space requires urgent intervention
- dexamethasone
- effective in reducing intracranial mass effect of tumors or infection
- not effective in reducing edema cause by hemorrhage or stroke
- contraindicated if CNS lymphoma suspected
- contraindicated if brain abscess suspected
- decompressive craniotomy or craniectomy
- reduces mortality & disability in patients with severe middle cerebral artery infarction (ischemic stroke)
Specific
intracranial abscess
intracranial hematoma
intracranial neoplasm
General
mass lesion
References
- Medical Knowledge Self Assessment Program (MKSAP) 16, 17.
American College of Physicians, Philadelphia 2012, 2015.