25. • Surgical: (Trans-shenoidal Transcranial)
• Pharmacological Rx (Dopamine agonist
Somatostatin analogs)
• Radiotherapy
Pituitary
• Depends on histology
• Resection and RadiotherapyPineal
• For solitary lesion or less than 4 lesions all < 3 cm. –
biopsy if undiagnosed, plus Gamma Knife
• For > 3 cm. tumor, surgery followed by WBRT
• For > 4 lesions, biopsy for diagnosis, plus whole
brain radiation therapy
Mets
27. • Intracranial haematomas
I. Extra dural haematomas :-
– between the dura & the skull
– middle meningeal artery
– Common site is temporal fossa.
TRAUMA
• Progressive deterioration of
level of consciousness
• Lucid Interval
• Pupillary changes :- called
Hutchinson’s pupillary
reaction.
Clinical
Features
EDH
29. • II. Subdural haematomas :-
–between the dura and the arachnoid.
–Common causes are bleeding from
superficial veins or venous sinuses.
–Anticoagulant treatment predispose to
intracranial bleeding and subdural
haematoma.
30. • Clinical features:
– Acute : Clinical features are similar to extra dural
hematoma.
– Chronic : Dementia, altered behaviour, psychiatric
manifestations or focal neurological deficits may
develop.
– In middle aged headache, contralateral
hemiplegia, papilledema
– children: vomiting, restlessness. Irritability, refusal
to feed, anaemia, seizures and failure to thrive.
31. Treatment:
•Craniotomy for Acute Subdural
Hematoma
•Surgical evacuation by Burr hole for
chronic subdural hematoma.
DIAGNOSIS:
•Acute-concave hyperdense lesion on CT
•Chronic- 0-10days(hyperdense)
10days-2wks(isodense)
>2wks(hypodense) lesions on CT.
32.
33.
34. BRAIN ABSCESS
• Mostly single may be multiple
• Majority Supratentorial, 10% infratentorial
• Metastatic:
– hematogenesis,direct spread from adjacent
structures or penetrating brain injury.
40. INTRACRANIAL TUBERCULOMA
• Mostly in developing countries caused by
Micro-bacterium tuberculus.
• Nodular or irregular avascular masses of
variable sizes surrounded by edema.
• Frequently multiple
• Common location: sub-cortical in cerebral
hemisphere.
41. Clinical presentation
Symptoms & signs of progressive intracranial
SOL:
– Raised ICP
– Focal neurologic deficits
– Seizures etc
– General malaise,fever in 50% patients.
42. INVESTIGATIONS
• Lab work-up
– Leukocytosis
– ESR- raised or normal
– Mantox test- often+ve
• Chest X-ray
• Plain skull X-ray
• CT & MRI- Investigation of choice
Hyper-dense masses with ring and surroundind
edema, often”Target sign”
