Focal neurological findings

Q1: What are the common conditions presenting with focal neurological findings?

• Vascular-stroke/focal cerebral ischemia, AVM, aneurysm
• Mass lesion-tumor, abscess
• Multiple sclerosis
• Trauma with intracranial hemorrhage

Q2: What are the common brain tumors?

• Adults-supratentorial
  • Metastases-bronchogenic CA, breast adenoCA, multiple myeloma
  • Glioblastoma multiforme-most common primary malignant tumor
  • Meningioma-most common benign tumor
• Children-infratentorial
  • Cerebellar astrocytoma
  • Medulloblastoma

Q3: What are the available procedures and their utility in the evaluation of a patient with focal neurological findings?

It will vary and depend on clinical suspicion.

• If suspected stroke, emergent CT. Doppler U/S of carotids (to detect carotid artery stenosis) or echocardiogram ( to find source of embolus) based on the clinical suspicion.
• If neoplastic disease:
  • MRI>CT
  • CT-guided stereotactic biopsy
  • Intraoperative U/S and CT both provide location and depth information to surgeon
• If multiple sclerosis: MRI
• If abscess: MRI>CT
• MRA can detect stenosis of large cerebral arteries, aneurysms, and other vascular lesions (sensitivity inferior to conventional angiography)
• Angiography to evaluate AVM, aneurysm, atherosclerosis and operable extracranial carotid lesions

Case 1:

Case 2:

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