or there may not be obvious block but dye column is broken down and there may be globulation and flocculation

total block, or there may not be obvious block but dye 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, and physiotherapy. 15. INTRACRANIAL TUMOURS Classification: 1. Neuroepithelial- Astrocytic tumours - Astrocytoma (most common primary benign tumour), glioblastoma, pilocytic astrocytoma Oligodenroglioma Ependymoma Choroid plexus tumours Pineal cell tumours Gangliocytoma/ganglioglioma Neuroblastoma Medulloblastoma (uncommon in adults), primitive neuro-ectodermal tumours Tumours of nerve sheath origin Schwannoma Neurofibroma Meningeal tumours Meningioma Meningeal sarcoma Tumours of mesenchymal origin Haemangiopericytoma Primary cerebral lymphoma Tumours of uncertain histogenesis Haemangioblastoma Tumours of germ cell origin Germinoma Teratoma Pituitary tumours Pituitary adenoma Others Craniopharyngioma colloid cyst Dermoid cyst Epidermoid cyst Cerebral metastasis -commonly from bronchus, breast or kidney. Local extension from adjacent tumors - Chordoma, glomus jugulare tumour. Infective granulomas - Tuberculoma, gumma. Parasitic cysts - Cysticercus, echinococcus. Clinical features - Symptoms - 1. RAISED INTRACRANIAL PRESSURE may be the result of (a) the mass itself. (b) Associated cerebral oedema. (c) Obstruction of CSF pathways causing hydrocephalus as in many tumors of posterior fossa. - (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- is sudden, projectile and not preceded by nausea. (c) Visual disturbance - consists of progressive loss of visual activity usually with episodes of transient blindness in both eyes (visual obscurations) lasting only a few seconds but increasing in duration and frequency with increasing intracranial pressure. (d) Intellectual deterioration, incontinence and disequilibrium if pressure increases over long period. (e) Drowsiness followed by coma if rapidly rising intracranial pressure. 2. EPILEPSY - is the presenting feature in upto 50% of tumours. 3. 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 of effect with self-neglet and intellectual deterioration. Tumors in posterior fossa give rise to ataxia, dysarthria and brain 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 syndrome associated with tumours e. g. neurofibromatosis. Investigations: A NON-RADIOGRAPH 1C 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 paroxysmal, later constant with intense exacerbations: cranial nerve palsies common. CT scan shows enormous dilatation of the ventricular