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Query: UMLS:C0017638 (glioma)
 30,880 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The effect of therapy on aphasic syndromes in patients with brain tumours is poorly documented. A case in which resection of a metastatic lesion led to resolution of a fluent dysphasia that had not responded to corticosteroid therapy is presented. As well as surgical and neurolinguistic interest this case demonstrates that CT diagnosis of malignant glioma can be erroneous and may lead to sub-optimal treatment.
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PMID:Resolution of fluent dysphasia following excision of metastatic carcinoma from the arcuate fasciculus. 138 37

A rare case of hemorrhage into a brain abscess in a 23-year-old man is reported. The patient complained of headache and low-grade fever on February 26, 1986. Two days later, he developed right hemiparesis and right hemisensory disturbance with mild consciousness disturbance and was admitted to a local hospital. Seven days after the onset, he suddenly became semicomatose, developed anisocoria and was consequently transferred to the University Hospital. On admission, his temperature was 37.5 degrees C and neurological examination revealed semicoma, anisocoria and right hemiparesis without nuchal rigidity. Enhanced CT scan showed a high density area within an irregular ring enhancement at the left basal ganglia. At that time, malignant glioma was diagnosed and an emergency operation was performed by left frontotemporal craniectomy. During the operation blood clot was found in the posterior part of the basal ganglia. After operation, a histological examination was made and a brain abscess was diagnosed. Gram staining revealed gram-positive bacillus. By aspiration of the abscess and chemotherapy, recovery was gradually made. He was discharged with motor dysphasia and mild right hemiparesis three months later. Differentiation between abscess and malignant glioma and the cause of the hemorrhage are discussed.
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PMID:[A case of hemorrhage into a brain abscess]. 322 75

A 55 year-old woman was admitted to hospital in January 1981 with transient expressive dysphasia. Past personal history was unremarkable except for a six-month history of renal colic and thrombophlebitis in the veins of the right leg. Computed tomographic scan of the head and carotid angiogram revealed a left calcified temporoparietal tumor. Because of pulmonary embolism it was decided to refute a cerebral biopsy. The patient also declined radiotherapy. In May 1983, a thorough workup revealed an incomplete fracture of the first lumbar vertebra and a diffuse demineralization of the rachis and pelvis. Four weeks later she developed temporal epilepsy and pulmonary embolism. A whole brain irradiation (60 Gy) was performed in August 1983. The patient's condition remained clinically stable until December 1984 when she was readmitted to hospital with a severe weight loss, diffuse osseous pain and pancytopenia. A bone marrow biopsy from the iliac crest showed a diffuse tumor involvement. Peroxidase-antiperoxidase staining using monoclonal antiserum to glial fibrillary acidic protein was strongly positive in numerous tumors cells. The pathological diagnosis was bone marrow metastasis by glioma. She died in March 1985, 4 years and 3 months after the first admission to hospital. Autopsy was not performed. A literature search reveals only 9 cases of extraneural spreading of astrocytomas and glioblastomas in the absence of previous craniotomy with post-mortem examination. The authors also comment on the clinical, pathological and histogenic aspects of extraneural metastasis of gliomas.
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PMID:[Spontaneous bone marrow micrometastasis of a cerebral glioma. Immunohistochemical diagnosis in a biopsy sample and review of the literature]. 352 91

One hundred and sixteen patients with high grade glioma were entered into a prospective phase two study and treated with accelerated radiotherapy from 1988 to 1993. In this cohort of patients we analysed speech deficit as a subdivision of global functional status in terms of incidence, category and prognosis for survival. Forty three patients (37%) had a speech deficit at presentation. Eighty percent of these had a component of expressive dysphasia, associated with considerable degree of awareness and distress. The overall median survival was 9.5 months. On univariate analysis, median survival in patients with speech difficulties (6 months) was worse than patients with normal speech (10.5 months) (log rang p = 0.005). Multivariate analysis established independent significance from age, Karnofsky Performance Status (KPS), gender, histological grade, extent of surgery and seizures. This paper highlights the importance of assessing individual categories of functional disability which in patients with high grade glioma include mobility, cognitive function and communication. Each of these factors may seriously affect an individual's activities of daily living, hence quality of life and separate analysis has a number of clinical implications. Firstly, with over a third of patients suffering speech difficulties, adequate speech therapy facilities should be freely available to score the degree of deficit, devise coping strategies and institute communication therapy. Secondly, an understanding of prognostic factors aids the critical analysis of phase two studies and the design and stratification of future prospective trials which should include an analysis of speech deficit. Thirdly, separating individual patients into good and bad prognostic groups can assist strategic management decisions.
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PMID:Speech and language disorders in patients with high grade glioma and its influence on prognosis. 767 91

The criteria for clinical response to treatment in cerebral glioma remain poorly defined, but could be made more objective if simple measures of neurological impairments were included in the definitions. We assessed the utility of simple fast previously validated tests of limb impairment (Timed nine hole peg test and 10 meter walk), memory (Williams delayed recall test) and language (Boston Aphasia Severity Rating Scale) in fifty patients with primary brain tumours to see if they could act as a surrogate for neurological impairment. The tests were compared with established measures of physical disability (Barthel Disability Index [BDI]) and handicap. Timed tests of hand function and gait were sensitive to minor impairments and were abnormal in patients with physical disability on BDI. Timed tests correlated well with handicap (rank correlation 0.734). Short term memory was impaired more commonly with tumours involving the left hemisphere (p < 0.01). Dysphasia limited testing of memory in 8%. Depression was associated with problems in limb function (p < 0.01), memory (p < 0.001), language (p < 0.001), BDI (p < 0.001) and handicap (p < 0.001). The number of abnormal fast tests also correlated with the severity of handicap (rank correlation 0.786) indicating that memory impairment and aphasia contribute to handicap and should be assessed. Median time to complete all assessments was 7 minutes 20 seconds. Utilization of these simple tests will add sensitivity and objectivity to evaluation of neurological response in clinical trials and can be performed quickly by non medical staff.
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PMID:Recording neurological impairment in clinical trials of glioma. 781 3

A patient with a remote infarct, seizures, mild hemiparesis, and dysphasia became obtunded over four months and died. Computerized tomography (CT) over 5 years showed a consistent, large, wedge-shaped left hemisphere hypodensity with a central calcification, but without signs of mass effect. This was interpreted as an infarct of the left middle cerebral artery territory. Post-mortem examination of the brain revealed the entire area appearing as infarct on CT was a gliosarcoma. We suspect that the unusual CT appearance of the lesion was likely caused by multiple pathologies: a low grade glioma transforming into a gliosarcoma that was able to spread throughout the area of infarct encephalomalacia without revealing a typical CT appearance of mass effect. The patient's brief period of deterioration probably coincided with transformation of the tumor into a gliosarcoma. The variable CT characteristics of gliosarcomas are reviewed.
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PMID:Unusual evolution and computerized tomographic appearance of a gliosarcoma. 808 41

The purpose of the study was to assess health-related quality of life (HQL) in patients with high-grade malignant glioma of the brain. The EORTC core Quality of Life Questionnaire (QLQ-C30) and a Brain Cancer Module (BCM20) were administered at baseline and several weeks later (follow-up) to 105 patients with either recently-diagnosed (n = 41) or recurrent (n = 64) malignant glioma. In addition, the attending neurologists completed a standard neurological examination, a modified Barthel Activities of Daily Living Index (BADLI) and the Karnofsky Performance Scale (KPS). In a preliminary step, the QLQ-C30 was found to have acceptable reliability (internal consistency and test-retest reliability). Newly-diagnosed patients and those with a KPS of 80-100 had significantly better physical, role and cognitive functioning and global quality of life with less fatigue, visual disorder, motor dysfunction, communication deficit, weakness of both legs and trouble controlling the bladder than did those with recurrent disease and those with a KPS of 50-70. Similarly, those capable of independent activities of daily living, as reported on the BADLI, had higher functioning scores and less fatigue than did those who were not independent. Patients with dysphasia, mental confusion or motor deficit on neurological examination reported significantly lower levels of physical, role, cognitive, emotional and social functioning and global quality of life than did patients not having these difficulties. They also had significantly more symptoms. In patients with deteriorating neurological status between baseline and follow-up, there was a marked decline in cognitive, physical, role, emotional and social functioning and global quality of life and an increase in fatigue. Thus, there are significant differences in HQL between patients with newly-diagnosed and recurrent brain cancer and between patients with differing KPS and BADLI scores. In addition, the HQL scores provide details not provided by the KPS and the BADLI. Deterioration in neurological function is accompanied by significant deterioration in a range of HQL domains and in global quality of life.
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PMID:Effect of neurological dysfunction on health-related quality of life in patients with high-grade glioma. 925 18

There is a need for valid objective tests of neurological improvement or deterioration to more accurately define response or progression in phase II studies of malignant glioma. The Edinburgh Functional Impairment Tests (EFIT) incorporate objective measures of upper and lower limb function, memory and a rating scale for dysphasia. We examined the intra-observer repeatability of the (EFIT) 24 hours apart in 55 patients with brain tumors and stable neurological disease and the inter-rater repeatability in 33 patients in the perioperative period (54 dual assessments). Intra-observer studies of the four subtests, failed to demonstrate any learning effect and showed close agreement. Inter-rater studies were affected by a treatment effect (steroids) and identified slight inter-rater bias for the ten meter walk. Altman-Bland plots showed that the level of agreement was less good in patients with more severe impairment. Correction for the severity of handicap was possible using a simple formulae: (timed tests: [rater 1 - rater 2]/[rater 1 + rater 2], Williams Delayed Recall Test [WDRT] (rater 1 - 2/81). Using this correction, all intra- and inter-rater variance of patients tested within 12 hours were < 0.2. A change of > or = 0.2 for the timed tests and WDRT, and a change in dysphasia score of > or = 2, represent a significant change in impairment using the EFIT. The EFIT should be a useful addition in phase II studies where objectively recording response or time to progression is important.
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PMID:Significant change in tests of neurological impairment in patients with brain tumours. 976 73

The left dominant insula was recently described as an essential area of speech, inducing definitive language disturbances when injured. We describe a patient with mild dysphasia, harboring a left insular glioma. A functional MRI found activations within the left inferior and middle frontal gyri, superior temporal gyrus, basal ganglia, but not in the insula. Surgery was performed using intraoperative electrical mapping in the awake patient, identifying the same language sites as showed by fMRI. A complete glioma resection was then performed. Despite an entire dominant insula removal, the patient presented no postoperative deficit, and even recovered from the preoperative dysphasia. This case illustrates the brain ability to maintain normal language without the left insula. The mechanisms of compensation are discussed.
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PMID:Functional compensation of the left dominant insula for language. 1144 26

Functional neuroimaging has improved pre-planning of surgery in eloquent cortical areas, but remains unable to map white matter. Thus, tumour resection in functional subcortical regions still presents a high risk of sequelae. The authors successfully used intraoperative electrical stimulations to perform subcortical language pathway mapping in order to avoid postoperative definitive deficit, and correlated these functional findings with the anatomical location of the eloquent bundles detected using postoperative MRI. At the same time, this also improved knowledge of fibre connectivity. Thirty patients harbouring a cortico-subcortical low-grade glioma in the left dominant hemisphere were operated on whilst awake using intraoperative electrical functional mapping during surgical resection. Language cortical sites and subcortical pathways were clearly identified and preserved in the 30 cases. The anatomo-functional correlations between data obtained using intraoperative subcortical mapping and postoperative MRI revealed the existence in all patients of common pathways which seem essential to language. This was shown by inducing reproducible speech disturbances during stimulations as follows: the subcallosal fasciculus (initiation disorders), the periventricular white matter (dysarthria), the arcuate fasciculus and the insular connections (anomia). Clinically, all patients except three presented a transient postoperative dysphasia, which resolved within 3 months. On control MRI, 14 resections were total and 16 subtotal due to infiltration of functional bundles described above. It is recommended that the combination of the techniques as described could prove ideal for future non-invasive reliable subcortical mapping both in healthy volunteers and in patients harbouring a (cortico)subcortical lesion in order to optimize surgical pre-planning.
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PMID:Intraoperative mapping of the subcortical language pathways using direct stimulations. An anatomo-functional study. 1183 4


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