May progress slowly over months or years simulating a spinal tumour with lesion localised to a single level, orwith multifocal spinal cord lesions. Investigations - (a) Plain X-ray of spine - may show vertebral caries. (b) CSF
Typically there is lymphocytic proliferation with 50-100 cells/cmm, and marked rise in proteins even upto 2-3gm/100 ml. (c) Myelogram - May show single level partial or total block, or there may not be obvious block butdye column is broken down and there may be globulation and flocculation (dripping candle appearance)Management - Antituberculous therapy, high doses of steroids with intrathecal steroid administration, andphysiotherapy. 15. INTRACRANIAL TUMOURS Classification: 1. Neuroepithelial- Astrocytic tumours -Astrocytoma (most common primary benign tumour), glioblastoma, pilocytic astrocytoma OligodenrogliomaEpendymoma Choroid plexus tumours Pineal cell tumours Gangliocytoma/ganglioglioma NeuroblastomaMedulloblastoma (uncommon in adults), primitive neuro-ectodermal tumours Tumours of nerve sheath originSchwannoma Neurofibroma Meningeal tumours Meningioma Meningeal sarcoma Tumours of mesenchymalorigin Haemangiopericytoma Primary cerebral lymphoma Tumours of uncertain histogenesisHaemangioblastoma Tumours of germ cell origin Germinoma Teratoma Pituitary tumours Pituitary adenomaOthers Craniopharyngioma colloid cyst Dermoid cyst Epidermoid cyst Cerebral metastasis - commonly frombronchus, breast or kidney. Local extension from adjacent tumors - Chordoma, glomus jugulare tumourInfective granulomas - Tuberculoma, gumma. Parasitic cysts - Cysticercus, echinococcus. Clinical features -Symptoms - 1. RAISED INTRACRANIAL PRESSURE may be the result of (a) the mass itself. (b) Associatedcerebral oedema. (c) Obstruction of CSF pathways causing hydrocephalus as in many tumors of posteriorfossa - (a) Headache- tends to occur in early morning and is usually described as vice-like or gripping pain,aggravated by activities which increase intracranial pressure such as coughing and straining. (b) Vomiting- issudden, projectile and not preceded by nausea. (c) Visual disturbance - consists of progressive loss of visualactivity usually with episodes of transient blindness in both eyes (visual obscurations) lasting only a fewseconds but increasing in duration and frequency with increasing intracranial pressure. (d) Intellectualdeterioration, incontinence and disequilibrium if pressure increases over long period. (e) Drowsiness followedby coma if rapidly rising intracranial pressure. 2. EPILEPSY - is the presenting feature in upto 50% of tumours3. FOCAL NEUROLOGICAL DEFICITS - depend on the location of the tumour Gradual onset of hemiparesis,hemianopia or dysphasia is typical of many supratentorial gliomas Frontal lobe tumors typically cause a loss ofeffect with self-neglet and intellectual deterioration. Tumors in posterior fossa give rise to ataxia, dysarthria andbrain stem and cranial nerve signs. Associated features - may include: (a) Signs of systemic malignancy. (b)Focal effects from tumours at base of skull e. g. proptosis, epistaxis. (c) Features of a congenital syndromeassociated with tumours e.g. neurofibromatosis Investigations: A NON-RADIOGRAPHIC INVESTIGATIONS
1. Visual field charting. 2. Audiometry skull percussion 'Setting sun' appearance of eyes, vomiting rare,mental deficiency. (b) Acquired - (i) Due to intracranial venous sinus thrombosis - papilloedema conspicuous,with little headache and vomiting. No focal signs. (ii) Due to meningitis - History of meningitis Headache at first
Typically there is lymphocytic proliferation with 50-100 cells/cmm, and marked rise in proteins even upto 2-3gm/100 ml. (c) Myelogram - May show single level partial or total block, or there may not be obvious block butdye column is broken down and there may be globulation and flocculation (dripping candle appearance)Management - Antituberculous therapy, high doses of steroids with intrathecal steroid administration, andphysiotherapy. 15. INTRACRANIAL TUMOURS Classification: 1. Neuroepithelial- Astrocytic tumours -Astrocytoma (most common primary benign tumour), glioblastoma, pilocytic astrocytoma OligodenrogliomaEpendymoma Choroid plexus tumours Pineal cell tumours Gangliocytoma/ganglioglioma NeuroblastomaMedulloblastoma (uncommon in adults), primitive neuro-ectodermal tumours Tumours of nerve sheath originSchwannoma Neurofibroma Meningeal tumours Meningioma Meningeal sarcoma Tumours of mesenchymalorigin Haemangiopericytoma Primary cerebral lymphoma Tumours of uncertain histogenesisHaemangioblastoma Tumours of germ cell origin Germinoma Teratoma Pituitary tumours Pituitary adenomaOthers Craniopharyngioma colloid cyst Dermoid cyst Epidermoid cyst Cerebral metastasis - commonly frombronchus, breast or kidney. Local extension from adjacent tumors - Chordoma, glomus jugulare tumourInfective granulomas - Tuberculoma, gumma. Parasitic cysts - Cysticercus, echinococcus. Clinical features -Symptoms - 1. RAISED INTRACRANIAL PRESSURE may be the result of (a) the mass itself. (b) Associatedcerebral oedema. (c) Obstruction of CSF pathways causing hydrocephalus as in many tumors of posteriorfossa - (a) Headache- tends to occur in early morning and is usually described as vice-like or gripping pain,aggravated by activities which increase intracranial pressure such as coughing and straining. (b) Vomiting- issudden, projectile and not preceded by nausea. (c) Visual disturbance - consists of progressive loss of visualactivity usually with episodes of transient blindness in both eyes (visual obscurations) lasting only a fewseconds but increasing in duration and frequency with increasing intracranial pressure. (d) Intellectualdeterioration, incontinence and disequilibrium if pressure increases over long period. (e) Drowsiness followedby coma if rapidly rising intracranial pressure. 2. EPILEPSY - is the presenting feature in upto 50% of tumours3. FOCAL NEUROLOGICAL DEFICITS - depend on the location of the tumour Gradual onset of hemiparesis,hemianopia or dysphasia is typical of many supratentorial gliomas Frontal lobe tumors typically cause a loss ofeffect with self-neglet and intellectual deterioration. Tumors in posterior fossa give rise to ataxia, dysarthria andbrain stem and cranial nerve signs. Associated features - may include: (a) Signs of systemic malignancy. (b)Focal effects from tumours at base of skull e. g. proptosis, epistaxis. (c) Features of a congenital syndromeassociated with tumours e.g. neurofibromatosis Investigations: A NON-RADIOGRAPHIC INVESTIGATIONS
1. Visual field charting. 2. Audiometry skull percussion 'Setting sun' appearance of eyes, vomiting rare,mental deficiency. (b) Acquired - (i) Due to intracranial venous sinus thrombosis - papilloedema conspicuous,with little headache and vomiting. No focal signs. (ii) Due to meningitis - History of meningitis Headache at first
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