2. Definition- any lesion occupying physical space
within the cranial cavity.
- These lesions put pressure on the adjacent
brain tissue and causing its damage
- Results in signs and symptoms due to
- >dysfunction of the nearby structure
- >raised intracranial pressure
- > electrical disturbance - seizures
4. The clinical features of icsol are divided into
following categories.
- s/s due to raised intracranial tension.
- Localising signs- these are the signs
which helps to detect the anatomical
site of the lesion.
- false localising signs- these are signs
which do not have localising value.
5. Increased head size and /or papilledema
- in infants there is separation of cranial
sutures,wide fontanels and increased head
circumference. Separation of the sutures
compensates for increase in intracranial
pressure.
MacEwen or crackpot sign- it indicates raised
intracranial pressure after sutures have closed.
Papilledema is unusual in infancy unless
intracranial pressure is very high.
6. -Vomiting – unexplained projectile vomiting with or without
headache.It is due to the direct pressure on the medullary
centre.
-Headache –early morning headache is highly suspicious.
-Diplopia and 6th nerve palsy- increased pressure displaces
the brainstem downwards ,thus stretching the 6th nerve and
results in paralysis of lateral gaze and diplopia.
7. Cranial nerve palsies- combined 6th & 7th nerve
involvement may suggest a pontine lesion.
Pseudobulbar palsy- it suggest 9th and 10th cranial
nerve involvement. In this the patient loses control of
facial muscles and has trouble chewing or speaking.
Head tilt- it is seen in superior oblique
paralysis,cerebellar lesions and posterior fossa tumours
Ataxia –occurs in cerebellar,spinocerebellar
tract,frontal lobe or thalmic lesions
Motor deficit- occurs in cerebral,brainstem & spinal
cord lesions
8. -Seizures- cortical or subcortical lesion.
-Decerebrate posturing- due to infratentorial lesions.
-Vision-impaired- vision with normal refraction should
arouse suspicion of lesion near optic nerve, optic
chiasma,optic radiation or cortical blindness.
9. Nystagmus - both irritative and destructive lesions of
cerebellovestibular system may cause nystagmus.
-personality disturbances,inappropriate sphincter control
and grasp response suggest localization of tumour near
the frontal lobe.
10. Brain tumours may be primary or secondary.
The primary tumours may be malignant or
benign.benign tumours located near the vital
area of brain may be life threatning.
Rapidly growing tumours represents earlier than
the slow growing tumours as in case of slow
growing tumours the various compensatory
mechanisms prevents the raise in ICT and
hence presents later in life .
11. Medulloblastoma- these are midline cerebellar
tumours occurs in infancy.These are fast
growing tumours.
-craniospinal spread along neuraxis is common
and death occurs rapidly.
Clinical features /-
-truncal ataxia
-early papilledema
-tendency to walk with broad base
-unsteadiness in sitting position
12. Astrocytoma
-astrocytoma arise from astrocytes – star shaped cells that
make up the supportive tissue of the brain.
Clinical features /-
-Nystegmus is observed on lateral gaze of the child the
affected side.
-Areflexia and hypotonia
-Head is tilted to the side of the lesion to relieve the
increased intracranial tension caused by herniation of
tumour or cerebellar tonsils through foramen magnum.
Treatment /-
Complete surgical excision of the tumour
- Chemotherapy with cisplatin,vincristine and tomustin.
13. Glioma of the brainstem/-
The usual age of onset is later half of first decade
of life.
-causes bilateral involvement of cranial nerves .
-cerebellar dysfunction is often present.
-they carry worst prognosis. Most children die
within 18 months.
Ependymomas of 4th ventricle/-
Arise from the ependymal cells lining the
ventricles of brain and centre of spinal cord.
-flow of CSF is obstruted causing early rise in ICT.
14. Craniopharyngioma/-
It is benign tumour arising from small nests of cells near the
pituitary stalk, occurs in sellar region near pituitary
gland.
Clinical features/-
-s/s due to raisd ICT
-symptoms due to pressure on optic tract-hemianopsia,unilateral visual
field defects
-growth failure
Endocrine abnormalities like diabetes insipidus & delayed puberty.
15. Glioma of cerebral hemisphere/-
-Occurs during 1st and 2nd decade of life
>clinical features /-
-seizures and hemiparesis
-ataxia due to involvement of frontopontine cerebellar fibers.
-vomiting,headache,papilledema
Hypothelmic glioma/-
These are rare tumours causing diencephalic syndrome.
-children fails to thrive,the subcutaneous fat is lost and have
sleep sleep and respiratory disturbance.
Glioma of optic nerve/-
c/f-
-visual disturbances ,squint,proptosis,exopthalmos and optic
atropthy.
16. These are most important causes of raised ICT and partial
seizures in childhood.
Neurocysticercosis and tuberculoma are the commenest
granulomas.
Neurocysticercosis /-
It is caused by larval stage of taenia solium.
Pathogenesis-It is an infestation of CNS with larval cyst of
pork tapeworm.Evolution occurs from a noattenuated cyst to
a ring with perilesional edema,to a disc lesion.which may
disappear,persist or even calcify.
17.
18. Clinical features/-
-Parenchymal neurocysticercosis-seizures ,raised ICT,focal
deficit & rarely meningeal signs
-Intaventricular neurocysticercosis- features due to raised
ICT,focal neurological deficit & hydrocephalous.
-Spinal neurocysticercosis-presents with features of spinal
cord compression .
Diagnosis /-
CT scan shows disc or ring like image with a hypodense
centre .MRI is more useful than CT scan in doubtful cases.
-ELISA
-CSF may be examined for cells ,cysticercal antigens & PCR
Treatment/-
-albendazole and praziquantel from 5 -28 days
-corticosteroides-2-3days before initiating therapy for 5 days
-anticonvalsants for 6-9 months but 2-3 yrs for calcified
lesion
19. Tuberculoma/-
Clinical presentation is similar to neurocysticercosis.
There is a single or multiple ring enhansing lesions.
Tuberculoma rings are usually large .The lesion often has a
thick irregular wall and associated with severe perilesional
edema.
Treatment/-antituberculous therapy is recommended for
1 year as for tubercular meningitis along with
corticosteroides for initial 6-8 weeks.
20. -Brain abscess is an important differential diagnosis among
children with unexplained fever,altered sensorium,elevated
intracranial pressure,localizing neurological findings and
headache
Predisposing factors – cyanotic heart
disease,immunosuppressed status,otitis
media,sinusitis,mastoiditis,systemic sepsis and post
traumatic.
Etiology- anaerobic organisms,streptococcus
aureus,pneumococci,proteus and haemophilus influenzae are
common infecting organisms
21. Clinical features/-
-Features due to raise intracranial tension
-Features suggesting toxemia-e.g fever ,chills & leukocytosis
-Manifestation of intracranial suppuration such as
irritability,drowsiness and meningeal irritation.
-Focal neurological signs such as focal convulsions,cranial nerve
palsies,aphasia,ataxia,visual field defects & neurological deficit.
- Diagnosis- is established by MRI or CT scan.
Management /-
Investigation for the source of infection,treatment of precipitating
cause ,management of raised ICT and symptoms.
Cephalosporin,vancomycin and metronidazole are continued for 4-
8 weeks.
- Surgical drainage or excision of the abscess should be done in case
of abscess of >2.5 c.m
