Differential Diagnosis of Space-Occupying Brain Lesions in two cases Shen yifan
Differen'al Diagnosis of Space-Occupying Brain Lesions in Two Cases Shen Yifan
Introduction Brain lesions The discovery of a cns lesion is made by head ct or MRI MRI has a number of advantages compared to ct scan CNS mass lesions can be classified into two categories according to the presence or absence of mass effect Mass Effect Space-Occupying effect
Introduc'on • Brain Lesions • The discovery of a CNS lesion is made by head CT or MRI. • MRI has a number of advantages compared to CT scan. • CNS mass lesions can be classified into two categories, according to the presence or absence of mass effect. • Mass Effect • Space-Occupying effect
AIDS patient with progressive multifocal leukoencephalopathy Pml PE 0aD 3 M TE Lac/Lp www
AIDS pa'ent with progressive mul'focal leukoencephalopathy (PML)
CNS lesions with mass effect Local presentations are characterized by the e presence o swelling edema, and mass effect on Midline surrounding structures Tentorium In some cases Uncal herniation especially for lesions Brainstem located in the posterior fossa, cerebral herniation occurs
CNS lesions with mass effect • Local Presenta2ons • are characterized by the presence of swelling, edema, and mass effect on surrounding structures. • In some cases, especially for lesions located in the posterior fossa, cerebral herniaFon occurs
Cerebral herniation 8 Tumor. 7
Cerebral hernia'on
CNS lesions with mass effect Venous volume Arterial volume Clinical manifestations CSF Brain Mass can present with headache, nausea vomiting, contusion, and lethargy, papilledema, all of which may reflect evidence of increased intracranial pressure Can cause neurologic focal impairment such as vision osS,weakness,sensory loss, aphasia, etc. Norma Compensated Decompensated normal Icp increased ICp
CNS lesions with mass effect • Clinical Manifesta2ons • can present with headache, nausea, vomiFng, confusion, and lethargy, papilledema, all of which may reflect evidence of increased intracranial pressure. • Can cause neurologic focal impairment, such as vision loss, weakness, sensory loss, aphasia, etc
Differential diagnosis of a brain mass Primary brain tumors Vascular disease Glioma Cerebral hemorrhage Meningioma Cerebral infarct Pituitary adenoma Vascular malformation Vestibular schwannoma Inflammatory Primary central nervous system Multiple sclerosis lymphoma Other Post-infectious encephalomyelitis Infections Granulomatous disease Abscess(bacterial, fungal, parasitic Vasculitis infection Textiloma Tuberculomas Metastatic brain tumors
Differen'al diagnosis of a brain mass Primary brain tumors Vascular disease Glioma Cerebral hemorrhage Meningioma Cerebral infarct Pituitary adenoma Vascular malformaFon VesFbular schwannoma Inflammatory Primary central nervous system lymphoma MulFple sclerosis Other Post-infecFous encephalomyeliFs InfecFons Granulomatous disease Abscess (bacterial, fungal, parasiFc) VasculiFs Viral infecFon TexFloma Tuberculomas MetastaFc brain tumors
Case 1 A 45 year-old female farmer presented with progressive weakness of left limbs and headache for more than a month she had no fever and received mannitol for controlling icp since the onset of the disease. physical examination showed a little nuchal rigidity and decreased muscle force of left limbs. Left Babinski sign presented
Case 1 • A 45 year-old female farmer presented with progressive weakness of leR limbs and headache for more than a month. She had no fever and received mannitol for controlling ICP since the onset of the disease. Physical examinaFon showed a liSle nuchal rigidity and decreased muscle force of leR limbs. LeR Babinski sign presented
Case 1 MRI ( Dec 15, 2015: Multiple space-occupying lesions in right frontal lobe and right thalamus region. T-spot(Dec 17, 2015 :+ Cryptococcus antigen(Dec 17, 2015) Lumber puncture(dec 17, 2015) Glucose 3.97mmol/ml, protein 875mg/LT, cells 106/L
Case 1 • MRI (Dec 15, 2015): MulFple space-occupying lesions in right frontal lobe and right thalamus region. • T-spot (Dec 17, 2015): + • Cryptococcus anFgen (Dec 17, 2015): - • Lumber puncture(Dec 17, 2015): • Glucose 3.97mmol/ml, protein 875mg/L ↑, cells 10^6/L
Differential diagnosis of a brain mass Primary brain tumors Vascular disease Glioma Cerebral hemorrhage Meningioma Cerebral infarct Pituitary adenoma Vascular malformation Vestibular schwannoma Inflammatory Primary central nervous system Multiple sclerosis lymphoma Other Post-infectious encephalomyelitis Infections Granulomatous disease Abscess(bacterial, fungal, parasitic Vasculitis infection Textiloma Tuberculomas Metastatic brain tumors
Differen'al diagnosis of a brain mass Primary brain tumors Vascular disease Glioma Cerebral hemorrhage Meningioma Cerebral infarct Pituitary adenoma Vascular malformaFon VesFbular schwannoma Inflammatory Primary central nervous system lymphoma MulFple sclerosis Other Post-infecFous encephalomyeliFs InfecFons Granulomatous disease Abscess (bacterial, fungal, parasiFc) VasculiFs Viral infecFon TexFloma Tuberculomas MetastaFc brain tumors
