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NS4 Neurosurgery
Differential Diagnoses of Common Presentations Toronto Notes 2019 Differential Diagnoses of Common Presentations
Intracranial Mass Lesions
Disorders of the Spine
Peripheral Nerve Lesions
Tumour
Metastasis
Astrocytoma
Meningioma
Vestibular schwannoma (acoustic neuroma) Pituitary adenoma
Primary CNS lymphoma
Pus/Inflammation
Cerebral abscess, extradural abscess, subdural empyema
Encephalitis (see Infectious Diseases, ID19) Tumefactive MS
Blood
Extradural (epidural) hematoma Subdural hematoma
Ischemic stroke
Hemorrhage: SAH, ICH, IVH
Cyst
Arachnoid cyst
Dermoid cyst
Epidermoid cyst
Colloid cyst (3rd ventricle)
Disorders of the Spine
Extradural
Degenerative: disc herniation, canal stenosis, spondylolisthesis/spondylolysis Infection/inflammation: osteomyelitis, discitis Ligamentous: ossification of posterior longitudinal ligament (OPLL)
Trauma: mechanical compression/instability, hematoma
Tumours (55% of all spinal tumours): lymphoma, metastases (lymphoma, lung, breast, prostate), neurofibroma
Intradural Extramedullary
Vascular: dural arteriovenous fistula, subdural hematoma (especially if on anticoagulants) Tumours (40% of all spinal tumours): meningioma, schwannoma, neurofibroma
Intradural Intramedullary
Tumours (5% of all spinal tumours): astrocytomas, ependymomas, hemangioblastomas and dermoids Syringomyelia: trauma, congenital, idiopathic Infectious/inflammatory: TB, sarcoid, transverse myelitis
Vascular: AVM, ischemia
Peripheral Nerve Lesions
Neuropathies
Traumatic Entrapments Iatrogenic Inflammatory Tumours
INTRACRANIAL PATHOLOGY
Intracranial Pressure Dynamics
Table 1. Approach to Intracranial Pathology
Issue
Vascular
Metabolic Infectious Tumour
Time Frame
Sudden
Hours to days Days to weeks Months
Features
No H/A = occlusive H/A = hemorrhagic
Affects entire CNS
Often a source of infection or immunodeficiency on history
Increased ICP: Initially → H/A Constant Progressive Severe
Worse in morning and/or wakes from sleep As ICP increases:
Blurry vision
Projectile vomiting (may initially present without nausea) Severely raised ICP:
Cushing’s reflex
1. Bradycardia
2. HTN
3. Respiratory irregularity