SPACE OCCUPYING LESION

Presented by: Elaine Moser Bano, RN. 

is a lesion that occupies space within the skull, it grows as mass but can grow diffusely, infiltrating tissue. A lesion is any abnormal

SPACE OCCUPYING LESION

tissue found on or in an organism, usually damaged by disease or trauma. Lesion is derived from the Latin word laesio which means injury.

It results to compression and infiltration of tissue and a lot of physiologic changes result, causing any or all of the following pathophysiologic events, Increased Intracranial Pressure, Seizure activity and neurologic signs. Intracranial space occupying lesions are tumors or abscesses present within the cranium or skull."Lesions
such as abscesses, haematomas, or tumours which form in an area where there is little room for expansion and which therefore compress the normal structures in the area: frequently they occur in the skull. Because the definition of a lesion is so broad, the varieties of lesions are virtually endless. They are subsequently classified by their features. If a lesion is caused by a tumor it will be classified as malignant versus benign. Lesions may be classified by the shape they form, as is the case with many ulcers, which can have a bullseye or 'target' appearance. Their size may be specified as gross or histologic depending on whether they are visible to the unaided eye or require a microscope to see. An additional classification that is sometimes used is based on whether or not a lesion occupies space. A space-occupying lesion, as the name suggests, occupies space and may impinge on nearby structures, whereas a non space-occupying lesion is simply a hole in the tissue, e.g. a small area of the brain that has turned to fluid following a stroke. The brain and spinal cord are enclosed by bone, hence expansion of their contents by a space-occupying lesion (SOL) leads to compression and distortion of the tissues of the CNS. Slowly enlarging SOLs can be accommodated by atrophy of adjacent brain or spinal tissue. More rapid enlargement causes a rise in pressure in the affected compartment from the normal level of < 2 kPa (< 15 mmHg), and herniation of the soft CNS tissue into adjacent compartments where the pressure is lower. This has potentially fatal consequences. Lesions are caused by any process that damages tissues. A cancerous tumor is an example of a lesion, however the surrounding tissue damaged by a tumor is also a lesion. Trauma, including head injury electrocution and chemical burns can also cause lesions.

Identification of the Case:

Patients Name: Mr.RD Address: Purok santol Cabawan, Rosario Agusan del Sur Birthday: March 20,1980 Status: Married Age: 30 years old Birth Place: Cabawan Agusan del Sur Occupation: Laborer Religion: Roman Catholic Nationality: Filipino Chief Complaint: Headache Admission date: December 23, 2010 Time : 01:50 am DIAGNOSIS: Space Occupying Lesion

History of Past and Present Illness:

Two days prior to admission patient complains of onset of headache followed by blurring of vision, nausea and loss of consciousness. Mr. RD is passive in smoking and occasionally drinks, his symptoms worsen every time he does straineous activities such as carrying heavy objects and barring down. 3 weeks ago, Mr. RD have had a motor accident but due to lack of money he was not able to seek medical treatment, and according to him he does not manifest any symptoms that would made him submit himself to seek for consultation, he just had a bruise on his face and head and some wounds in his hands. The first symptom he remembered is headache he thought it was a typical headache he self medicate with Paracetamol every time the pain is present. Hypertension Diabetes Mellitus Bronchial Asthma Tuberculosis

*Present admission *Previous Operation *Allergies FAMILY MEDICAL HISTORY: Hypertension Diabetes Mellitus Asthma Malignancy

PATHOPHYSIOLOGY

Predisposing factor: Genetics

Precipitating factor: Head injury secondary to vehicular accident

Trauma to the scalp, skull or brain

Abrasion, contusion, laceration, or hem atoma beneath the layers of the tissue

Swelling/ Hemorrhage/Edema

Limited space for expansion within the skull Causes changes in Volume of the brain tissue, blood & CSF

Displacement or shifting of CSF

Increase absorption of CSF

Decrease Cerebral Blood Volume

Increase Intracranial Pressure

Obstructed blood flow and decreased tissue perfusion

Brain cannot store oxygen and glucose

Altered level of consciousness Nausea &Vomiting

confusion

headache

seizures

changes in vital signs(hypertension) visual disturbances

If treated: Prognosis depends on extent of brain injury

If not treated: Irreversible brain damage Coma Death

SYMPTOMATOLOGY: Ideal and Presenting Symptoms 1. Increase Intracranial Pressure Description Gradual compression of the brain by enlarging lesion, as its compensatory adjustments may occur through compression of intracranial veins. Common symptom, worsen by coughing, straining or sudden movement. It is caused by the mass invading compression or distorting the pain sensitive structures or by edema that accompanies the lesion. Dull and unrelenting. When specific regions of the brain is disrupted alterations in cognitive function occur and language disturbances is present. Motor cortex compression - Visual loss in one half of the visual field. - Involuntary rhyththmical eye movement. Due to increased ICP. Due to increased ICP Due to compression and pressure on blood vessels tends to constrict and increase blood supply. Enlarging occupying lesion Present 

2. Headache

3. Mental Status changes

4. Seizure 5. Visual disturbances - Homonymous hemianopsia - Nystagmus 6. Vomiting( Projectile) 7. Nausea 8. Increase Blood Pressure

  

9. Motor Function changes

presses the cerebellum, abnormalities in motor function may present. DIAGNOSTIC TEST: Description: a. CT SCAN -imaging that gives specific information concerning the number, size, and density and extent of the lesions.

b. MRI

Is helpful in the diagnosis of brain tumors/ lesion, it is used in the detection of lesion it is particularly helpful in detecting tumors in the brain stem and pituitary regions where bone interferes with CTscan.

c. Cerebral Angiography

Provides visualization of cerebral blood vessels and can localized most cerebral tumors and mass. Can detect abnormal brain waves in regions occupied by a tumor and it is used to evaluate temporal lobe seizures and assist in ruling out other disorders. Studies of the CSF may be performed to detect malignant cells because tumors of the CNS are capable of shedding cells into the CSF.

d. ECG

e. Cytology

f. Xray

To localized the tumor/ mass to verify its position.

MEDICAL MANAGEMENT: DRUGS: a. Corticosteriods b. Antihypertensive Are useful in relieving headache and alterations of consciousness. Reduces inflammation around the metastatic deposits and decreases the edema surrounding. To normalizes increase Blood pressure and to manage Increase intracranial pressure. To decrease the fluid content of the brain which leads to decrease ICP. Prevent and treat seizure. Progression in the doses and type of analgesic agents needed for effective relief.

c. Osmotic agents ( mannitol, glycerol) d. Anticonvulsant (phenytoin) e. Pain relievers

SURGERY: a. Radio surgery b. Radiation therapy Allows deep, inaccessible tumors to be treated, often in a single session. Decreases recurrences of incompletely resected tumors/ mass. Conventional surgical approach that requires an incision into the skull to release tension.

c. Craniotomy

NURSING MANAGEMENT: INDEPENDENT NURSING MANAGEMENT: 1. Neurologic checks/ flow chart - monitor cognitive and comprehension of the pt some of them experience neurologis dysfunction. 2. Monitor Vital signs- to determine if there are changes and abnormalities that the patient is manifesting. 3. Reorients the patient when necessary to person, time, and place- use of orienting devices( personal possesions, photograph, list, clock) 4. Prevention of injury- patients with seizures and paralysis is closely monitored. 5. Glasgow Coma scale/ Motor function evaluation- is checked at intervals because specific motor deficits may involved. 6. Assisting in Self Care- additional support system is needed by them to make their activities of daily living. 7. Render health teachings- in imparting knowledge the patietn will be able to lessen the tendency of injury and harm and be able to have idea on how to prevent further complications.

DEPENDENT NURSING MANAGEMENT: 1. Medicated and Properly Monitored. 2. Continuously Administered Intravenous Fluid as ordered.