Raised intracranial pressure from tumour — SCE Neurology MCQ

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EasyNeuro-oncologyRaised intracranial pressure from tumourSCE Neurology

A 27-year-old woman presented with morning headache, vomiting and transient visual obscurations with known glioma. On examination, there was papilloedema and sixth nerve palsy. Initial investigations showed: MRI showed tumour progression with obstructive hydrocephalus. What is the most appropriate investigation?

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Correct answer: E — MRI brain with gadolinium

MRI brain with gadolinium is the best answer because the vignette describes Raised intracranial pressure from tumour: papilloedema and hydrocephalus indicate raised intracranial pressure needing urgent management. MR venography is plausible in a neighbouring presentation, but the chronology, examination or investigation pattern does not match the key discriminator here. Nerve conduction studies and EMG and MRI internal auditory meatus with gadolinium are less appropriate because they would require different localisation, timing or test findings; Video-EEG telemetry would fit a different syndrome. Clinical pearl: migraine does not cause papilloedema or ventricular enlargement.

Reference: NICE NG99; EANO guidance; ABN paraneoplastic guidance