Primary CNS tumours presenting with raised intracranial pressure require a tissue diagnosis. Ventricular shunting may be used in patients with hydrocephalus due to lesions situated in areas difficult to access surgically. However, if at all possible histological confirmation should be sought, as it has a major bearing on the therapeutic approach.

High-grade gliomas may occasionally have a substantial cystic component that, even in the setting of recurrent disease, may be drained, leading to rapid resolution of elevated intra-cranial pressure.

Patients with malignant meningitis can present with features suggesting raised intracranial pressure and often have associated cranial nerve palsies. This is often an ominous development in epithelial tumours, but may also occur in some primary CNS tumours, especially medulloblastoma and pineal region tumours; MRI may demonstrate meningeal tumour deposits. The diagnosis can otherwise be confirmed by lumbar puncture, seeking malignant cells in the CSF, although this must be preceded by CT scan to exclude hydrocephalus.

Chapter 36 Stridor

Aetiology 607 Diagnosis 608 Treatment 609

Stridor is the term applied to the high pitched musical noise produced by turbulent airflow through narrowed upper airways. It is caused by partial obstruction of the airway either in the region of the larynx or inferiorly in the trachea or major bronchi. Because of the anatomy of the larynx, obstruction above or at the level of the vocal cords produces predominantly inspiratory stridor, whereas obstruction in the subglottis or trachea causes biphasic stridor.

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