Space Occupying Lesions (SOL) of the Brain - Clinical Manifestation with Subtle Neurological Symptoms in Emergency Department

A space-occupying lesion of the brain is commonly due to malignancy but could be other underlying pathologies as well [1]. The effects of SOL may be local or due to compression of adjacent brain structures. Patients may also have behavioral disturbances or cognitive dysfunction [2,3].

Aims & Objectives:

1. To identify SOL patients presenting with elusive symptoms in Emergency Department.
2. To avoid diagnostic delay of SOL.
3. To find the underlying cause and to initiate early management.

Methods: This is a retrospective study involving 150 patients who presented in ED Rashid Hospital with neurological symptoms over a period of 12 months commencing from 01/01/2015 until 31/12/2015.

Results: As for presenting symptoms, 81 (54%) presented with Seizures, 31 (21%) with a headache, 17 (11%) had both a headache and vomiting, 8 (5%) with unconsciousness and those by abnormal behavior (3%). Five (3%) were having a motor deficit, and two (1%) had vomiting without a headache and confusion.

As for underlying diagnosis, 78 (52%) were diagnosed with infectious causes and 62 (41%) with a brain tumor. Among the infectious causes, 58 (74%) presented with seizures, 11 (14%) with an isolated headache and 4 (5%) with both a headache and vomiting.

On the other hand, the headache was the commonest presentation in brain tumor patients, i.e., 18 (29%) followed by seizures in 17 (27%), headache and vomiting in 11 (18%) and neurological deficit in 10 (16%) patients.

Conclusion: A headache with or without vomiting, seizure and acute psychological disturbances may be a warning sign of a wide variety of an intracranial space occupying lesion (SOL) including malignancy.