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1. What are the five main causes of a space-occupying intracranial lesion?
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Correct answer:
(1) Haemorrhage
(a) extradural;
(b) subdural, acute or chronic;
(c) intracerebral.
(2) Tumour.
(3) Hydrocephalus.
(4) Brain swelling (oedema), e.g. head injury, encephalitis.
(5) Cerebral abscess. Other causes are rare and include hydatid cysts, tuberculoma and gumma.
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2. How does a space-occupying lesion manifest itself?
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Correct answer:
By the general features of raised intracranial pressure and by localizing signs.
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3. How does a space-occupying lesion produce raised intracranial pressure?
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Correct answer:
A space-occupying lesion within the skull produces raised intracranial pressure not only by its actual volume within the closed box of the cranium but also by provoking oedema, and sometimes by impeding the circulation or absorption of cerebrospinal fluid causing hydrocephalus.
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4. Can you give an example of a situation in which a space-occupying lesion will produce clinical features of raised intracranial pressure rapidly?
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Correct answer:
For example, a tumour in the posterior fossa may rapidly present with severe symptoms of raised intracranial pressure secondary to hydrocephalus.
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5. What are the main clinical features of a slowly progressive rise in intracranial pressure?
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Correct answer:
(1) Headache: may be severe, often present when the patient wakes and is aggravated by straining or coughing.
(2) Vomiting: often without preceding nausea.
(3) Papilloedema: which may be accompanied by blurring of vision and may progress to permanent blindness.
(4) Depressed conscious level.
(5) Neck stiffness: particularly if the lesion is in the posterior fossa.
(6) Diplopia, ataxia.
(7) Enlargement of the head: in children before the sutures have fused.
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6. What is the result of a rapid rise in intracranial pressure?
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Correct answer:
A rapid rise in intracranial pressure results in a clinical picture of intense headache with rapid progression into coma.
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7. How can raised intracranial pressure enlarge the head?
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Correct answer:
This can occur in children before the sutures have fused.
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8. What type of headache is characteristic of a raised intracranial pressure?
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Correct answer:
The headache may be severe, often present when the patient wakes and is aggravated by straining or coughing.
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9. What are the characteristics of vomiting caused by raised intracranial pressure?
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Correct answer:
Vomiting often occurs with no preceding nausea.
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10. How dangerous is the papilloedema caused by raised intracranial pressure?
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Correct answer:
This may be accompanied by blurring of the vision and may progress to permanent blindness.
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11. What does upper motor neurone weakness indicate with regard to the localization of a space-occupying lesion?
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Correct answer:
This may indicate a lesion of the pyramidal pathway.
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12. What does a bitemporal hemianopia indicate with regard to the location of a space-occupying lesion?
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Correct answer:
The lesion is at the optic chiasma.
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13. What is the result of a space-occupying lesion of the postcentral cortex?
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Correct answer:
A lesion of the postcentral cortex may produce loss of fine discrimination and of stereognosis.
