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Everything about Supratentorial sol-space Occupying lesion (SOL)

  • Posted on- Jan 06, 2018
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A supratentorial SOL is a process performed for the treatment of brain tumor that is occurred due to other pathologies such as an abscess or a haematoma. Almost half of the intracerebral tumors are primary but the rest have originated outside the CNS and are metastases.


SOL of the tumor occurs because of some reasons or signs such as an abscess or a haematoma. Almost half of the intracerebral tumors are primary but the rest have originated outside the CNS and are metastases.


The tumor caused effect could be local, due to the leveling brain difficulty and presentation gives a sign of the location of the lesion but not its aetiology (set of causes).


There may be more general symptoms related to raised intracranial pressure or seizures, behavioral changes, or false localizing signs. Big lesions (injury) such as the frontal lobe may be relatively silent whilst a small lesion in the dominant hemisphere may devastate speech.


What are the symptoms of SOL?



Many of these features may be due to raised intracranial pressure.

  • A headache
  • A headache caused due to brain tumor is not the common headache as compared to a tension or a migraine headache.
  • A change in the pattern or frequency of headaches is a cause for concern.
  • A headache is more common in posterior fossa tumors and rapidly growing tumors.
  • Vomiting may occur. This may be without accompanying nausea.
  • Nausea may be a feature.
  • Sudden behavioral change should be taken seriously.
  • A case of weakness, ataxia or disturbance of gait.
  • Poor localizing signs can be even deficits of speech
  • There may be generalized convulsions.


Due to general irregular movement of the body, trying for getting a good history. The first features of the episode may be a good localizing sign.


If the raised intracranial pressure is suspected, it is imperative to use the ophthalmoscope to look for papilloedema. This may be more marked in children than in adults.


If epilepsy starts in middle age or beyond, a space-occupying lesion of the brain is one of the possible diagnoses that should be considered.


Many patients have headaches. Very few have brain tumors. A meticulous approach is required to identify those few.


What is the cause of SOL?

  • Metastases, gliomas, meningiomas, pituitary adenomas and acoustic neuromas account for 95% of all brain tumors.
  • In adults, two-thirds of primary brain tumors are supratentorial, however, in children, two-thirds of brain tumors are infratentorial.
  • Primary cerebral tumors include astrocytomas, glioblastoma multiforme, oligodendrogliomas and ependymomas.
  • Primary brain tumors do not usually metastasize.
  • About 30% of brain tumors are metastatic and of these about 50% are multiple. About 15-20% of people with metastatic cancer develop cerebral metastases.
  • The most common primary is lung cancer followed by breast cancer, carcinoma of the colon and malignant melanoma.


What are the effects of SOL?


Symptoms shown below are taken on the basis of ipsilateral pressure in some cases however, one Uncas may push the midbrain against the contralateral tentorium, causing compression of the contralateral cerebral peduncle, with hemiparesis ipsilateral to the side of the herniation. The changes in the peduncle in this setting are referred to as Kernohan’s notch.


  •  Compression of cranial nerve III.

The third nerve passes from the posterior cerebral to superior cerebellar arteries, is laid down and shows hemorrhage. The first clinical sign is ipsilateral pupil dilation since the parasympathetic fibers are located on the outside of the nerve and are inactivated first by compression. Complete third nerve paralysis may also occur.

 

  •  Compression of midbrain cerebral peduncles.

Most often the ipsilateral cerebral peduncle is compressed, resulting in contralateral hemiparesis or hemiplegia. In addition, the cerebral peduncle on the side opposite the space-occupying lesion may be compressed against, or indented by, the free edge of the tentorium cerebelli. This results in ipsilateral hemiparesis or hemiplegia (if it occurs alone) or quadriplegia (if both peduncles are compressed).


Minimum cost of supratentorial SOL is Rs.3,30,000 to maximum Rs.6,60,000.



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