Intracranial mass

Clinical Features

• Vary depending on size, location, and nature of mass

Headache Red Flags

Features

• Sudden onset or accelerating pattern
• Maximum intensity of pain at onset (i.e. "thunderclap")
• Worse with valsalva
• Worse in the morning or at night
• No similar headache in past
• Age >50 yr or <5 yr
• Occipitonuchal headache
• Visual disturbances
• Exertional or postcoital
• Family or personal history of SAH, cerebral aneurysm, or AVM
• Focal neurologic signs
• Diastolic BP >120
• Papilledema
• Jaw claudication

Clinical Context

Headache in setting of:

• Infection
• Cancer
• Immunosuppression
• Seizure
• Syncope
• Trauma
• Altered mental status
• Systemic illness (fever, stiff neck, rash)
• Nausea/vomiting
• Patient on anticoagulation, steroids, NSAIDs, antiplatelet

Differential Diagnosis

Intracranial Mass

• Intracranial hemorrhage
  • Intra-axial
    • Hemorrhagic stroke (Spontaneous intracerebral hemorrhage)
    • Traumatic intracerebral hemorrhage
  • Extra-axial
    • Epidural hemorrhage
    • Subdural hemorrhage
    • Subarachnoid hemorrhage (aneurysmal intracranial hemorrhage)
• Brain tumor
• Brain abscess
• Subdural empyema
• Epidural abscess (intracranial)

Management

• Treat specific process
• Consider seizure prophylaxis
• See also Management of Elevated Intracranial Pressure