A RARE CASE OF SPACE OCCUPYING LESION OF BRAINSTEM IN AN ELDERLY MALE PATIENT (original) (raw)
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Cureus
Benign paroxysmal positional vertigo (BPPV) is a common vestibular disorder. It accounts for a third of all vestibular disorders diagnosed in the general population and is usually diagnosed and treated successfully. This article presents two cases of BPPV in a 52-year-old man and a 45-year-old patient, respectively. Both patients presented with recurrent episodes of vertigo associated with certain head movements. Medical history for the first patient included surgery for acoustic neuroma 12 months before developing the vertigo episodes. The second patient underwent a neurosurgical operation for glioblastoma multiforme (GBM) followed by radiotherapy three months before this presentation. Both patients were diagnosed with right-sided posterior canal BPPV after the Dix-Hallpike test. Their symptoms completely resolved within few minutes of the Epley maneuver. These cases highlight the importance of diagnosing and treating a potentially curable condition that can coexist in some patients with brain tumors.
Frontiers in Oncology, 2016
Brainstem gliomas are not nearly as common in adults as they are in children. They are likely the final common consequence not of a single disease process but of several. They can be difficult to diagnose, and are challenging to treat. Clinical studies of this diagnosis are few and generally small. Because of these factors, our understanding of the biology of adult brainstem glioma is incomplete. However, the knowledge base is growing and progress is being made. In this article, we review the current state of knowledge for brainstem glioma in adults and identify key areas for which additional information is required.
Adult brainstem gliomas - retrospective analysis of 51 patients
Turkish Neurosurgery, 2016
the specific pathology all BSG must be considered malignant because their localization itself is inoperable (23). These tumors are most often localized in pons, often with infiltration in other regions of the brainstem (16). They characteristically present with multiple cranial nerve deficits, ataxia and long tract dysfunction (5,6,10). The simplest classification of BSG is into two groups as focal and diffuse (4,8). More complex grading system defined subtypes of tumors of the brainstem, according to localization, the presence of hydrocephalus and hemorrhage and growth model (5,7,11,13). AIm: Brainstem gliomas (BSG) constitute less than 2% of brain tumors in adults. Therapeutic options are limited and BSG are associated with a high morbidity and mortality. mATERIAl and mEThODS: We reviewed the records of 51 patients with BSG treated at the Institute of Neurosurgery, Clinical Center of Serbia in Belgrade between 1998 and 2012. We recorded demographic and clinical variables as well as radiological findings and survival. RESUlTS: Of the 51 patients, 62.7% were male and 37.3% were female. The mean age was 30.6±19.3 years. High grade glioma (Astrocytoma grade III and IV) was most common at the age of 38.2±17.9 years (t=.481, p=0.017) while low grade glioma (Astrocytoma grade I and II) was common in younger age as 25.4±17.4 years (X 2 =4.013; p=0.045), with localization in the pons (X 2 =5.299; p=0.021) and exophytic presentation (X 2 =3.862; p=0.049). Ataxia, as initial symptom, was a predictor of poor outcome (HR:5.546, p=0.012). CONClUSION: Due to its specific localization, BSG present a major challenge for neurosurgery, because of the necessity of safe approach for radical resection. Histological verification of BSG determines the need for additional therapeutic procedures such as radiotherapy and chemotherapy. Benefit from correct diagnosis is reflected in the avoidance of potentially adverse effects of treatment.
Brainstem gliomas in adults: prognostic factors and classification
Brain, 2001
In contrast to childhood brainstem gliomas, adult brainstem gliomas are rare and poorly understood. The charts of 48 adults suffering from brainstem glioma were reviewed in order to determine prognostic factors, evaluate the effect of treatment and propose a classification of these tumours. Mean age at onset was 34 years (range 16-70 years). The main presenting symptoms were gait disturbance (61%), headache (44%), weakness of the limbs (42%) and diplopia (40%). Four patterns were identified on MRI, representing nonenhancing, diffusely infiltrative tumours (50%), contrastenhancing localized masses (31%), isolated tectal tumours (8%) and other patterns (11%). Treatment consisted of partial resection (8%), radiotherapy (94%) and chemotherapy (56%). Overall median survival was 5.4 years. On univariate analysis, the following favourable prognostic factors were identified (P < 0.01): age of onset <40 years, duration of symptoms before diagnosis >3 months, Karnofski performance status >70, low-grade histology, absence of contrast enhancement and 'necrosis' on MRI. On multivariate analysis, the duration of symptoms, the appearance of 'necrosis' on MRI and the histological grade of the tumour remained significant and independent prognostic factors (P < 0.05). Eighty-five percent of the tumours could be classified into one of the following three groups on the basis of clinical, radiological Abbreviations: CI ϭ confidence interval; NF1 ϭ neurofibromatosis type 1
Brainstem glioma clinical features and treatment outcomes: a case series
International Journal of Scientific Reports
A diverse category of gliomas that mostly affect youngsters are known as brainstem gliomas (BGs). The diffuse intrinsic pontine glioma (DIPG), exophytic medullary glioma, and tectal glioma can be divided into categories based on architecture and clinical behaviour. The most frequent BG is DIPG. The median age at start is 6.5 years, and the median survival is less than a year. The fact that adults with DIPG live longer suggests that their tumours are less aggressive and have physiologically distinct origins than those in children. Patients may appear with one or more of the following symptoms: ataxia, long tract signs, or malfunction of the cranial nerves. The majority of the pons is occupied by an infiltrative lesion on magnetic resonance imaging, and contrast enhancement is typically not noticeable. Fractionated radiation is the norm in medicine.
Case Report on Brain Stem Glioma
Journal of Pharmaceutical Negative Results
Brain stem glioma is one of the diseases of CNS. It is brain and spinal cord tumor. It is a type of tumor caused when healthy cells in the brain stem change and increase abnormally and forms a mass that mass called as tumor. This tumor may be malignant. It grows abnormally and spread other parts of body. Glioma is a tumor, it grows from glial cell is supportive cell in the brain. A 13 year old male patient presented in neurology ward with the chief complaint of difficulty chewing and swallowing food, drooping of the face on left side, difficulty while talking, weakness in the left arms and legs, unable to walk along with Headache and Vomiting. After examination and specific investigation following blood test, cytology and MRI scan, the patient was diagnosed as brain stem glioma. Initial management was done by Physician by antibiotic, intravenous fluid, some vitamin and nutritional supplement and diuretics to remove fluid into body. Following the appropriate treatment patient’s condi...
Medullary brainstem gliomas in an adult: A rare case report and challenging tumor
Surgical Neurology International
Background: Medullary brainstem lesions are rare tumors that are challenging to treat due to their location in the brainstem, which controls vital functions such as breathing, heart rate, and blood pressure. While the most common subtype is the aggressive diffuse intrinsic pontine glioma, other subtypes exist, including focal brainstem gliomas and cervicomedullary gliomas. The prognosis for patients with brainstem gliomas is generally poor, and treatment options are limited. Early detection and treatment are crucial to improve outcomes for patients with these tumors. Case Description: In this case report, the authors describe a 28-year-old male from Saudi Arabia who presented with headaches and vomiting. Imaging studies and clinical examination revealed a high-grade astrocytoma medullary brainstem lesion. The patient underwent radiation therapy and chemotherapy, effectively controlling tumor growth and improving his quality of life. However, a residual tumor remained, and the patien...
Tumors of the Central Nervous System
Annals of Internal Medicine, 1953
Tumors that present in infancy tend to be more insidious because of the nonspecifi c nature of the clinical symptoms, including vomiting, irritability, lethargy, macrocephaly, failure to thrive, and loss of, or delay in, attaining developmental milestones [4,6]. Older children may better communicate specifi c neurologic deficits. Additionally, signs and symptoms related to increased ICP, including headache, nausea, and vomiting (particularly upon awakening in the morning), frequently occur in this age group as well [4,6]. Supratentorial tumors produce signs and symptoms according to the area of the brain that is affected [4,6]. For example, cerebral hemispheric lesions may present with focal neurologic fi ndings or seizures, whereas tumors proximal to the optic chiasm and hypothalamus may produce vision loss, visual fi eld defects, or endocrine abnormalities [6]. Cerebellar tumors, on the other hand, frequently result in ataxia, gait disturbances, and signs of increased ICP secondary to obstruction of the fourth ventricle [4,6]. Brain stem tumors present with cranial nerve abnormalities and/or upper motor neuron signs [4,6]. Signs and symptoms associated with specifi c tumor types are discussed in more detail in the following sections. Gliomas Tumors of glial origin constitute approximately 50% of all primary brain tumors in children and are grouped based on histopathologic appearance into low-grade and high-grade gliomas [4,6,8,9]. These tumors are found throughout the central nervous system, and location is an important prognostic factor [3,10]. Low-grade gliomas are a heterogeneous group of tumors with an overall 10-year survival rate of greater than 80% with appropriate treatment [3,11]. The most frequent low-grade gliomas are posterior fossa and cerebral hemisphere astrocytomas. Most low-grade gliomas are classifi ed into two histopathologic types: pilocytic astrocytomas (World Health Organization, WHO grade I) and diffuse or fi brillary astrocytomas (WHO grade II) [3]. Pilocytic astrocytomas occur primarily in young children with a median age of 4 years [3]. These tumors can occur at all levels of the neuroaxis but occur most frequently in the cerebellum and the optic pathways [12]. On radiographic imaging, nearly all are brightly enhancing, well-circumscribed tumors that are clearly demarcated from surrounding brain tissue and have little surrounding edema; about half of them are cystic [3,12]. In contrast,
Surgical treatment and prognosis of adult patients with brainstem gliomas
Neurologia i Neurochirurgia Polska, 2018
Brainstem gliomas account for only 1-2% of all adult gliomas and are characterized by poor prognosis. In particular, unfavourable prognosis is related to patients with enhancing high-Grades III and IV gliomas (WHO classification) and diffuse brainstem gliomas. However, in the latter group the prognosis is better than in children [1-3]. A 5-year survival was reported in 58% of adult patients with diffuse brainstem gliomas, which n e u r o l o g i a i n e u r o c h i r u r g i a p o l s k a 5 2 (2 0 1 8) 6 2 3-6 3 3 a r t i c l e i n f o