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intracranial neoplasm
Etiology:
1) primary brain tumor
2) metastatic tumor (most common, see brain neoplasm)
3) meningioma
4) schwannoma
Physical examination:
- neurologic examination
- attention assessment
- language assessment
- visual field testing
- cranial nerve examination
- cranial nerve 3 palsy, dilated & unreactive pupil may indicate brainstem compression or herniation
- cranial nerve 6 palsy may result from increased intracranial pressure
Clinical manifestations:
- seizures
- increased intracranial pressure
- ataxia
- focal neurologic deficits
Special laboratory:
- ophthalmoscopy
- brain biopsy
- lumbar puncture, CSF analysis
- generally not necessary
- indicated if CNS infection, multiple sclerosis, or primary CNS lymphoma is suspected
Radiology:
- neuroimaging
- contrast-enhanced magnetic resonance imaging
- brain metastases appear as ring-enhancing lesions at the gray-white cortical junction
- not contrast head CT useful in emergency setting to rule out intracranial hemorrhage or cerebral herniation [1]
Differential diagnosis:
- intracranial mass lesion (non-neoplastic)
- brain abscess
- toxoplasmosis
- CNS tuberculoma
- sarcoidosis
- demyelinating disease: mulitple sclerosis
- vascular malformation
- radiation necrosis
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
- decompressive craniotomy or craniectomy
- reduces mortality & disability in patients with severe middle cerebral artery infarction (ischemic stroke)
Specific
brain neoplasm (intracranial neoplasm)
General
intracranial mass lesion
neoplasm; tumor
References
- Medical Knowledge Self Assessment Program (MKSAP) 17, 18, 19.
American College of Physicians, Philadelphia 2015, 2018, 2021.