SPACE

OCCUPYING
LESION
Presented by:
Elaine Moser Bano, RN.

SPACE OCCUPYING LESION

is a lesion that occupies space

within the skull, it grows as mass but can grow diffusely, infiltrating tissue. A
lesion is any abnormal tissue found on or in an organism, usually damaged by
disease or trauma. Lesion is derived from the Latin word laesio which means injury.

It results to compression and infiltration of tissue and a lot of

physiologic changes result, causing any or all of the following
pathophysiologic events, Increased Intracranial Pressure, Seizure activity and
neurologic signs. Intracranial space occupying lesions are tumors or
abscesses present within the cranium or skull."Lesions such as abscesses,
haematomas, or tumours which form in an area where there is little room for
expansion and which therefore compress the normal structures in the area:
frequently they occur in the skull. Because the definition of a lesion is so broad, the
varieties of lesions are virtually endless. They are subsequently classified by their
features.
If a lesion is caused by a tumor it will be classified as malignant versus
benign. Lesions may be classified by the shape they form, as is the case with many
ulcers, which can have a bullseye or 'target' appearance. Their size may be
specified as gross or histologic depending on whether they are visible to the
unaided eye or require a microscope to see. An additional classification that is
sometimes used is based on whether or not a lesion occupies space. A spaceoccupying lesion, as the name suggests, occupies space and may impinge on
nearby structures, whereas a non space-occupying lesion is simply a hole in the
tissue, e.g. a small area of the brain that has turned to fluid following a stroke.
The brain and spinal cord are enclosed by bone, hence expansion of their
contents by a space-occupying lesion (SOL) leads to compression and distortion of
the tissues of the CNS. Slowly enlarging SOLs can be accommodated by atrophy of
adjacent brain or spinal tissue. More rapid enlargement causes a rise in pressure in
the affected compartment from the normal level of < 2 kPa (< 15 mmHg), and
herniation of the soft CNS tissue into adjacent compartments where the pressure is
lower. This has potentially fatal consequences.
Lesions are caused by any process that damages tissues. A cancerous tumor is an
example of a lesion, however the surrounding tissue damaged by a tumor is also a
lesion. Trauma, including head injury electrocution and chemical burns can also
cause lesions.

Identification of the Case:

Patients Name: Mr.RD
Address: Purok santol Cabawan, Rosario Agusan del Sur
Birthday: March 20,1980
Status: Married
Age: 30 years old
Birth Place: Cabawan Agusan del Sur
Occupation: Laborer
Religion: Roman Catholic
Nationality: Filipino
Chief Complaint: Headache
Admission date: December 23, 2010
Time : 01:50 am
DIAGNOSIS: Space Occupying Lesion

History of Past and Present Illness:

Two days prior to admission patient complains of onset of headache
followed by blurring of vision, nausea and loss of consciousness. Mr. RD is
passive in smoking and occasionally drinks, his symptoms worsen every time
he does straineous activities such as carrying heavy objects and barring
down. 3 weeks ago, Mr. RD have had a motor accident but due to lack of
money he was not able to seek medical treatment, and according to him he
does not manifest any symptoms that would made him submit himself to
seek for consultation, he just had a bruise on his face and head and some
wounds in his hands. The first symptom he remembered is headache he
thought it was a typical headache he self medicate with Paracetamol every
time the pain is present.
-

Hypertension
Diabetes Mellitus
Bronchial Asthma
Tuberculosis

*Present admission
*Previous Operation
*Allergies
FAMILY MEDICAL HISTORY:

Hypertension
Diabetes Mellitus
Asthma
Malignancy

PATHOPHYSIOLOGY

Predisposing factor:

Precipitating factor:

Genetics

Head injury secondary to vehicular

accident

Trauma to the scalp, skull or brain

Abrasion, contusion, laceration, or hem

atoma beneath the layers of the tissue

Swelling/ Hemorrhage/Edema

Limited space for expansion within the skull

Causes changes in Volume of the brain tissue, blood & CSF

Displacement or shifting of CSF

Increase absorption of
CSF

Decrease Cerebral Blood

Volume

Increase Intracranial Pressure

Obstructed blood flow and decreased tissue perfusion

Brain cannot store oxygen and glucose

Altered level of consciousness

Nausea &Vomiting

confusion

headache

seizures

changes in vital signs(hypertension) visual disturbances

If treated:

If not treated:

Prognosis depends on extent of brain injury

Irreversible brain damage

Coma
Death

SYMPTOMATOLOGY: Ideal and Presenting

Symptoms
1. Increase Intracranial
Pressure

2. Headache

Description
Gradual compression of the
brain by enlarging lesion, as
its compensatory adjustments
may occur through
compression of intracranial
veins.
Common symptom, worsen
by coughing, straining or
sudden movement. It is
caused by the mass invading
compression or distorting the
pain sensitive structures or by
edema that accompanies the
lesion. Dull and unrelenting.

Present

3. Mental Status changes

When specific regions of the

brain is disrupted alterations
in cognitive function occur
and language disturbances is
present.

4. Seizure
5. Visual disturbances
- Homonymous
hemianopsia
- Nystagmus

6. Vomiting( Projectile)

Motor cortex compression

- Visual loss in one
half of the visual
field.
- Involuntary
rhyththmical eye
movement.
Due to increased ICP.

7. Nausea

Due to increased ICP

8. Increase Blood Pressure

9. Motor Function changes

Due to compression and

pressure on blood vessels
tends to constrict and increase
blood supply.
Enlarging occupying lesion
presses the cerebellum,
abnormalities in motor
function may present.

DIAGNOSTIC TEST:
Description:
a. CT SCAN

-imaging that gives specific information

concerning the number, size, and density
and extent of the lesions.

b. MRI

Is helpful in the diagnosis of brain

tumors/ lesion, it is used in the
detection of lesion it is particularly
helpful in detecting tumors in the
brain stem and pituitary regions where
bone interferes with CTscan.

c. Cerebral Angiography

Provides visualization of cerebral

blood vessels and can localized most
cerebral tumors and mass.

d. ECG

Can detect abnormal brain waves in

regions occupied by a tumor and it is
used to evaluate temporal lobe
seizures and assist in ruling out other
disorders.

e. Cytology

Studies of the CSF may be performed

to detect malignant cells because
tumors of the CNS are capable of
shedding cells into the CSF.

f. Xray

To localized the tumor/ mass to verify

its position.

MEDICAL MANAGEMENT:
DRUGS:
a. Corticosteriods

b. Antihypertensive

c. Osmotic agents
( mannitol, glycerol)
d. Anticonvulsant (phenytoin)
e. Pain relievers

Are useful in relieving headache

and alterations of consciousness.
Reduces inflammation around the
metastatic deposits and decreases
the edema surrounding.
To normalizes increase Blood
pressure and to manage Increase
intracranial pressure.
To decrease the fluid content of the
brain which leads to decrease ICP.
Prevent and treat seizure.
Progression in the doses and type of
analgesic agents needed for
effective relief.

SURGERY:
a. Radio surgery

b. Radiation therapy

Allows deep, inaccessible tumors to

be treated, often in a single session.
Decreases recurrences of
incompletely resected tumors/

c. Craniotomy

mass.
Conventional surgical approach that
requires an incision into the skull to
release tension.

NURSING MANAGEMENT:
INDEPENDENT NURSING MANAGEMENT:
1. Neurologic checks/ flow chart - monitor cognitive and comprehension of the pt some of
them experience neurologis dysfunction.
2. Monitor Vital signs- to determine if there are changes and abnormalities that the patient
is manifesting.
3. Reorients the patient when necessary to person, time, and place- use of orienting
devices( personal possesions, photograph, list, clock)
4. Prevention of injury- patients with seizures and paralysis is closely monitored.
5. Glasgow Coma scale/ Motor function evaluation- is checked at intervals because
specific motor deficits may involved.
6. Assisting in Self Care- additional support system is needed by them to make their
activities of daily living.
7. Render health teachings- in imparting knowledge the patietn will be able to lessen the
tendency of injury and harm and be able to have idea on how to prevent further
complications.

DEPENDENT NURSING MANAGEMENT:

1. Medicated and Properly Monitored.
2. Continuously Administered Intravenous Fluid as ordered.