BRAIN OEDEMA AND DISORDER OF I.C.

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Brain oedema
Definition : Increase in brain volume due to an

increase in water and sodium content

Classification

1-Vasogenic (extra cellular): Increase capillary

permeability lead to increase extra cellular fluid which as plasma &plasma protein caused by e.g. brain tumours,abscess ,infection ,trauma and haemorrage..
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2- Cytotoxic(cellular): Decrease capillary

permeability lead to increase intracellular fluid which as water and sodium caused by hypoxia, hypo osmalarity e.g. water intoxication. 3- Interstitial (hydrocephalic): Increase brain fluid especially extra cellular due to block C.S.F absorption caused by obstructive hydrocephalus

Hydrocephalus
Definition : Increase cerebrospinal fluid (C.S.F )
volume and dilatation of the cerebral ventricles Classification : 1- Obstructive: Due to congenital malformation , post-inflammatory ,post- hemorrhagic and mass lesion 2- Communicating : Due to overproduction of

C.S.F, defective absorption of C.S.F. and

insufficiency of venous drainage .
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3- Normal pressure: Due to obliteration or insufficiency of transcortical subarachnoid space. my occur alone or with an impaired absorption defect .

BRAIN TUMERS
A- Supratentorial: 1- Meningioma: Supposed to be arise from arachnoidal tissue and frequently near the venous sinuses it has a tendency to become calcified (psammoma) this type of tumors characteristically infiltrates the skull but compress the brain .

The common site of tumors is :

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1- Parasagital areas 2- Lateral surface of temporal lobe 3- Sphinoidal ridge 4- Olfactory groove

5- Suprasellar
6- Cerebropontin angle

2- Craniopharyngioma: Arise from congenital remnants of rasthke`s pouch common site is suprasellar and age of onset 10-30 Y 3- Cholesteatoma: It is epidermoid which arises from congenital remnants of cells the common site

cerebropontinangel (C.P.A) and temporal lobe

4- Astrocytoma: (most common glioma) It arise from astrocyte the cerebellum common site in children and cerebral hemisphere in adult .
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5- Oligodendroglioma: Rare type of glioma and

occipital lobe its common site 6- Ependymoma: Aris from ependymal cell its common site vermis of cerebellum and floor of fourth ventricles lead to increase I,C.T 7- Glioblastoma multiform : Highly malignant glioma it common site cerebral hemisphere and rare in the occipital region.
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8- Spongioblastoma polar: Pones and optic chiasma are the common sits 9- Pineal body tumors : Midbrain is the common sit lead to endocrinal disturbances 10-Tumors of pituitary gland .

B- Infratentorial tumors: 1- Medulloblastoma: Occure mostly in children before age of 10 years it arises from

undifferentiated cell rests in the vermis or in the

posterior modularly velum which form the roof of

the fourth ventricle ,lead to increase intracranial

tension and ataxia

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2- Cerebellar astrocytoma: located in the cerebellar hemisphere when it occurs in children 3- Cerebellar angioblastoma: Arises from embryonic vascular cells and it is frequently located on one cerebellar hemisphere .

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4- Acoustic neuroma: Commonly located in cerebello- pontin angle which a benign tumor arises from the sheath of the vestibular branch of the auditory nerve inside the internal auditory meatus.

The tumor may occur in middle age when it is usually

single or it may develop in young age when it is

frequently multiple .

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Clinical diagnosis of tumors

General:
1- Headache: It is the first symptom in 35% of patients and occurs later in 70% morning headache or those that waken the patients from sleep.

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2- Vomiting or nausea: Due to increase I.C.P involvement of the chemoreceptor trigger zone in the medulla may lead to projectile vomiting. 3- Facial pain: Due to distribution of the trigeminal nerve with tumors at the base of the skull.

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4- Seizures: Are the first symptom in 30%of brain tumors and brain tumors account for only 5% of all patients with epilepsy. Slowly growing tumors and those in the rolandic fissure tend to be the most epileptogenic. The association between brain

tumors and seizures increase with age.

5- Alteration in consciousness : May be evident in 20% of patients at the time of diagnosis and vary from subtle personality changes to confusion to coma.
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Focal symptoms and signs :

1- Frontal lobe: Are initially silent, with time there may be personality change, impaired judgment and gait abnormalities.

2-Temporal lobe : Seizure which range from

simple olfactory hallucination, feeling of fear to

complex partial seizure.

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3- Parietal lobe: loss cortical sensation and hemiparesis . 4- Occipital lobe : Visual field change . 5-Thalamic: Contralateral sensory loss, cognitive

changes and rarely aphasia .

6- Brain stem: Cranial nerve disturbances .

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7- Pineal body: Signs and symptoms of increase I.C.P. and precocious puberty 8- Intraventricular: Hydrocephalus and increase I.C.P.

9- Cerebellar: Headache and ataxia.

10- Skull base: Affect cranial nerve

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False localizing signs :

may arise from increase I.C.P. the most common is :

1- Sixth cranial nerve due to compression of

abducent nerve over petrous ridge.

2- Ipsilateral hemiparesis: Due to compression of

contralateral cerebral peduncle against tentorium .

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3- Bitemporal hemianopia: Due to compression

optic chiasma at lateral side

4- Giat abnormalities 5- Endocrinal deficit

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Diagnosis:
Careful history and neurological examination, C.T scan & brain M.R.I with & without contrast.

Treatment:
Surgical resection partial or complete radiotherapy and or chemotherapy.

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THANK YOU

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