intracranial neoplasm

Etiology

• primary brain tumor
• metastatic tumor (most common, see brain neoplasm)
• meningioma
• 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

Diagnostic procedures

• 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

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)

More general terms

• intracranial mass lesion
• neoplasm; tumor

More specific terms

• brain neoplasm (intracranial neoplasm)