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These symptoms are caused by a combination of increased intracranial pressure due to a space-occupying lesion (headache, vomiting, confusion, coma), infection (fever, fatigue etc.) and focal neurologic brain tissue damage (hemiparesis, aphasia etc.).
Severely raised ICP, if caused by a unilateral space-occupying lesion (e.g. a hematoma) can result in midline shift, a dangerous sequela in which the brain moves toward one side as the result of massive swelling in a cerebral hemisphere. Midline shift can compress the ventricles and lead to hydrocephalus. [21]
Kernohan's notch is an ipsilateral condition, in that a left-sided primary lesion (in which Kernohan's notch would be on the right side) evokes motor impairment in the left side of the body and a right-sided primary injury evokes motor impairment in the right side of the body. [4]
Collier, however, was "unable to accept this explanation", his view being that since the sixth nerve emerges straight forward from the brain stem, whereas other cranial nerves emerge obliquely or transversely, it is more liable to the mechanical effects of backward brain stem displacement by intracranial space occupying lesions. [7]
The symptoms will mimic those of space-occupying lesions. [7] Blood-borne spread certainly occurs, presumably by crossing the blood–brain barrier, but a proportion of patients may get TB meningitis from rupture of a cortical focus in the brain; [8] an even smaller proportion get it from rupture of a bony focus in the spine. [9]
[4] [5] A space-occupying lesion, as the name suggests, has a recognizable volume 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. [1] Lesions may also be classified by the shape they form.
Such causes include hydrocephalus (an accumulation of cerebrospinal fluid [CSF] around the brain), space occupying lesions in the brain such as tumors, subdural hematomas or other subdural fluid collections, arachnoid cysts, craniosynostosis (early closure of the cranial sutures)(especially of the lambdoid suture), hyperostosis (an excessive ...
Space-occupying lesions in the brain (abscesses, tumours) are one cause of unprovoked seizures. [3] In people with brain tumours, the frequency of epilepsy depends on the location of the tumor in the cortical region. [30] Abnormalities in blood vessels of the brain (Arteriovenous malformation) can also cause epilepsy. [3]