Beruflich Dokumente
Kultur Dokumente
7-2014
Sameen Khalid
Ziauddin Hospital karachi
Shafaq Alvi
Neuro Clinic and Care ,Karachi ,Pakistan.
Recommended Citation
Soomro, Bashir A.; Khalid, Sameen; and Alvi, Shafaq (2014) "Analytic study of clinical presentation of intracranial space-occupying
lesions in adult patients," Pakistan Journal of Neurological Sciences (PJNS): Vol. 9 : Iss. 3 , Article 2.
Available at: http://ecommons.aku.edu/pjns/vol9/iss3/2
O R I G I N A L A R T I C L E
Correspondence to: Bashir A. Soomro, 43/ II Zulfiqar Street No: 03, Phase VIII DHA, Karachi. Postal Code: 75500. Email: basoomro@gmail.com
Date of submission: July 5, 2014, Date of revision: September 10, 2014, Date of acceptance: September 22, 2014
ABSTRACT
Background: Intracranial space-occupying lesions can be caused by a variety of disease processes, ranging from
neoplasms to non-neoplastic lesions including hematomas, abscesses and vascular malformations. This article provides
an overview of varied clinical presentations of patients with intracranial space-occupying lesions.Methods:A total of
200 cases of intracranial space-occupying lesions presenting at Neuro Clinic and Care were retrospectively analyzed.
Adult patients from all age groups and both genders were included in this study. Results: 165 patients (82.5%) had
neoplastic lesions while 35 (17.5%) had non-neoplastic lesions. Metastatic lesions from primary tumor elsewhere in the
body comprised the most common group with81 cases (40.5%), followed by meningiomas with 27 cases (13.5%).
Males were affected slightly more than females (1:0.8). The most common presenting symptom was headache 87
patients (43.5%,) followed by focal symptoms such as numbness, tingling or weakness being present in 80 (40%)and
seizures observed in 65 (32.5%).Conclusion: The study reviews the wide range of symptoms the patients with intracra-
nial space-occupying lesions present with, the most common being headache, followed by focal symptoms such as
numbness, tingling or weakness, seizures and vomiting. Knowledge of these typical as well as atypical patterns of clinical
presentation can aid physicians in timely detection and prompt application of diagnostic and therapeutic modalities.
Key Words: Intracranial space-occupying lesions, Primary brain tumors, Clinical presentation.
False
Generalized
Localizing &
Signs & Localizing Signs & Symptoms
Lateralizing
Symptoms
Signs
Headache CN lesions Temporal Lobe:
Behavioral changes
Nausea, Horner's
Depersonalization
Vomiting Syndrome
Hallucinations
Seizures Cerebellar Quadrantanopia
signs Complex partial or generalized
Personality seizures
changes
Change in Frontal Lobe :
Personality changes
mental status
Hemiparesis
Memory loss Expressive aphasia
Motor deficits Anosmia
Sensory
deficits Parietallobe:
Deficits of Spatial disorientation
speech or Hemisensory loss
vision Receptive aphasia
Hemianopia
Papilledema
Occipital Lobe :
Contralateral hemianopia
Cerebellum:
Ataxia
Dysmetria
Nystagmus
Cerebello-pontine angle
(Acoustic neuroma):
Ipsilateral deafness
Tinnitus
Nystagmus
Ipsilateral cerebellar signs
Facial and Trigeminal palsies
Pituitary tumors:Endocrine symptoms
Visual defects
the integrity of posterior column occurred in 14% hearing tests (Rinne and Weber ) and was found to be
(n=28). Cerebellar signs such as nystagmus, positive impaired in 6.5% (n=13). Gag reflex assessing cranial
finger-nose and heel-shin tests and impaired rapid nerves IX and X was absent in 6% of the cases (n=12).
alternating movements were present in 24% Only 2 patients (1%) had impaired active and passive
(n=48).Level of consciousness was impaired in a quarter neck movements showing compromised function of
of the patients (25%, n=50) with 27.5% of the patients cranial nerve XI while tongue mass and movements
(n=55) not oriented to person, place and/or time. Memory demonstrating intactness of cranial nerve XII were
impairment was found in 36.5% of the cases (n=73) impaired in 1.5% of the patients (n=3).
and higher cortical functions that were evaluated by serial
sevens and calculations were also impaired in 36.5% DISCUSSION
(n=73). Speech impairment was present in 13.5% of
the cases (n=27). Loss of smell occurred in 1.5% Both neoplastic and non-neoplastic intracranial
(n=3). Cranial nerve II impairment demonstrated by space-occupying lesions share features of clinical
compromised visual acuity, visual fields and by fundoscopic presentation. In a study involving 100 cases of intracranial
examination showing papilledema was found in 32% space occupying lesions conducted in Lahore,
(n=64). Pupillary response and extraoccular muscle Pakistan,(1) neoplastic lesions comprised 89% of the
movements were impaired in 12% of the patients cases while non-neoplastic lesions were reported to be
(n=24). Facial sensations, corneal reflex and Masseter’s 11%, which gives a similar proportion as in our study of
bulk and power (demonstrating integrity of cranial nerve 200 cases comprising of 82.5% neoplastic and 17.5%
V) were impaired in 2.5% (n=5) while cranial nerve VII non-neoplastic lesions. Males were affected slightly
evaluated by checking facial movements was impaired in more than females in their study giving a sex ratio of 1.7:
24.5% (n=49). Cranial nerve VIII was evaluated by 1, which correlates with the results of our study.
Author’s Contribution:
Dr. Bashir Soomro: Study concept and design, protocol writing, data collection, data analy-
sis, manuscript writing, manuscript review
Dr. Sameen Khalid: Data collection, data analysis, manuscript writing, manuscript review
Dr. Shafaq Alvi: Study concept and design, protocol writing, data collection, data analysis,
manuscript
Dr. Shafaq Alvi: Study concept and design, protocol writing, data collection, data analysis,
manuscript writing, manuscript review