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

Diagnostic procedures

• 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)

More general terms

• mass lesion

More specific terms

• intracranial abscess
• intracranial hematoma
• intracranial neoplasm