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Query: UMLS:C0018681 (headache)
 56,091 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A case of astrocytoma with extracranial extension after malignant transformation is presented. The patient was a 58-year-old female who suffered from headache. The initial magnetic resonance imaging (MRI) demonstrated a slightly hyperintense tumor on T 2-weighted images in the tip of the left temporal lobe, and no contrast enhancement on gadolinium-enhanced T 1-weighted images(Gd-T 1 WI). On digital subtraction angiography, there was no tumor staining. The initial diagnosis was made as low-grade astrocytoma. However two months later, her symptoms aggravated suddenly. MRI revealed a remarkably growing tumor with ring-like enhancement on Gd-T 1 WI. She underwent a temporal lobectomy, which pathologically demonstrated a glioblastoma. After surgery, chemotherapy and radiotherapy were performed. The tumor invades the skull base and extended into the infratemporal fossa 25 months after surgery.
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PMID:[A case of astrocytoma with extracranial extension after malignant transformation]. 1268 96

A 40-year-old man had experienced headaches for 6 days and a 51-year-old man (2 weeks after an operation for perianal abscess) had experienced tingling sensations in the left hand for 10 days. After an epileptic seizure both underwent a CT scan of the brain. On these an abnormality was visible, probably a malignant astrocytoma. After several days of complaint reduction with dexamethasone, drowsiness and leftsided hemiparesis occurred. Emergency operations revealed a brain abscess. In the younger patient drainage and the administration of antibiotics were followed by fatal brain oedema. In the eldest drainage and the administration of antibiotics were followed by the extraction of infected teeth; he recovered with a slight loss of strength in the left hand. Brain abscesses are rare in the Netherlands. The diagnosis can be difficult because clinical signs and symptoms are not specific and because an underlying systemic infection is often not apparent. Diffusion-weighted magnetic resonance imaging can nowadays differentiate purulent brain processes from cystic brain tumors. Early treatment (burr hole aspiration and antibiotics) is usually curative. Nevertheless, mortality continues to be almost 10% and (permanent) morbidity 45%.
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PMID:[Brain abscess: a difficult diagnosis]. 1290 52

Lesions consistent with cavernous angiomas (CAs) of the brain are sometimes seen on MRI scans of the brains of patients who received radiation therapy for brain tumors as children. The lesions appear years later within brain tissue that was included in radiation fields. It is unclear whether these MRI-detected lesions are true CAs or a pathological variant. This study reports the clinical, radiographical, and pathological findings in 3 cases of radiation-induced CAs of the brain. From 1995 to 1997, 3 patients previously treated with radiation therapy (45-55 Gy) for pediatric brain tumors (medulloblastoma, ependymoma, and a presumed midbrain astrocytoma) underwent resections of symptomatic and enlarging lesions that were consistent with a CA of the brain. All of the lesions occurred within fields of prior irradiation. None of the patients had received chemotherapy as part of their cancer treatment. CA-presenting symptoms included seizures, cranial nerve deficits, and headaches. The lesions appeared 7-19 years after radiation therapy and slowly enlarged on subsequent imaging studies. MRI scans of the lesions revealed characteristics typical of CA. The lesions became symptomatic 1-5 years after they were initially noted. Surgical resection was performed 1-2 years after symptoms began. The age at resection ranged from 15 to 23 years (10-21 years after radiation therapy). Pathological analysis of the three lesions showed typical CA characteristics. Some CAs may be caused by radiation therapy for pediatric brain tumors. They are radiologically and pathologically similar to sporadically occurring CAs of the brain and may enlarge over time and become symptomatic. CAs can be safely resected using standard microsurgical techniques.
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PMID:Pathologically proven cavernous angiomas of the brain following radiation therapy for pediatric brain tumors. 1294 1

Most cases of periaqueductal tumours were found in children and adolescents, so treatment modalities in adults are not evaluated yet. A case of 40 years old woman with tectal and periaqueductal protoplasmatic astrocytoma grade II with history of headache and episodes of syncope is described. MRI showed triventricular hydrocephalus. After a shunt procedure she was doing well for about 15 months. Then she became somnolent, disoriented, and Parinaud syndrome appeared. The solid tumour was resected microsurgically in one stage. A part of it was removed via the supracerebellar infratentorial approach and tectal plate incision. The remainder of the tumour was removed through the fourth ventricle and the aqueduct which was filled by tumour mass. Postoperatively bilateral ptosis, vertical gaze palsy, slight horizontal gaze limitation and pupilloplegia were the main neurological sequelae. They all almost completely resolved within a year. The patient is doing well two and half years after the surgery. MRI showed patency of the aqueduct and no residual tumour. The authors suggest, that direct surgical attempt at total tumour removal should be considered in cases of periaqueductal and tectal gliomas. They also believe it is the first described case, in whom this type of tumour was totally removed by a combined transtectal and transaqueductal route.
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PMID:One stage removal of periaqueductal glioma in adult via infratentorial supracerebellar and transaqueductal approaches. 1496 51

Multiple metastatic brain tumors and multifocal primary brain tumors of a single histological type are well described in the literature. The concurrent presence of multiple primary brain tumors with different histological characteristics, however, is very rare. The authors describe the first known case in which an oligodendroglioma and a juvenile pilocytic astrocytoma (JPA) presented as synchronous primary brain tumors in the same patient. This 43-year-old man presented with a 2-month history of progressive headaches, nausea, and vomiting. Magnetic resonance imaging demonstrated an enhancing heterogeneous right medial cerebellar lesion and a larger calcified, nonenhancing, heterogeneous right frontal lesion with surrounding edema and a mass effect. The results of a metastatic workup were unremarkable. The patient underwent an initial right frontotemporal craniotomy and a subsequent suboccipital craniectomy 2 years later for resection of the posterior fossa lesion. Histological examination revealed the frontal and cerebellar lesions to be an oligodendroglioma and JPA, respectively. A molecular analysis detected a deletion of chromosome 1p36 in the oligodendroglioma, but not in the JPA. After the initial operation, the patient received follow-up care for his oligodendroglioma, but eventually required temozolomide for tumor progression. His condition remains stable both neurologically and according to imaging studies. The authors describe the first known case in which a low-grade oligodendroglioma and a JPA presented as synchronous primary brain tumors. They review the literature on multiple primary brain tumors with different histological characteristics and discuss potential mechanisms for the development of these lesions.
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PMID:Oligodendroglioma and juvenile pilocytic astrocytoma presenting as synchronous primary brain tumors. Case report with histological and molecular differentiation of the tumors and review of the literature. 1507 Jan 26

Adult patients with a magnetic resonance scan suggestive of a supratentorial low-grade glioma should generally undergo at least a stereotactic biopsy to confirm the diagnosis and rule out an anaplastic glioma or a non-neoplastic lesion. Early tumor treatment should be given to patients with newly diagnosed low-grade gliomas who are over age 50 years, those who have headaches or neurologic deficits other than seizures, or those whose neuroimaging studies show tumor growth or mass effect. For younger patients presenting with seizures and no other neurologic symptoms, it is reasonable to defer therapy until there is clinical or radiographic tumor progression. When it is judged that intervention is necessary, patients should undergo the maximal surgical tumor resection, which preserves or improves neurologic function. For younger (<50 years) astrocytoma patients with a good tumor resection, radiation may be deferred until tumor progression. Early radiation should be given to astrocytoma patients who are older than 50 years of age at diagnosis (regardless of the type of surgery) or to younger patients who are judged to require early intervention but who are not candidates for aggressive surgical resection. The radiation dose for low-grade glioma should be 4500 to 5000 cGy, preferably with three-dimensional conformal ports. The same guidelines for management apply to patients with low-grade oligodendroglioma or oligoastrocytoma, except that chemotherapy is a reasonable alternative to radiation when it is judged that treatment other than surgical resection is required.
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PMID:Low-Grade Gliomas in Adults. 1515 4

This 17-year-old male patient with tuberous sclerosis developed increased headaches and lethargy. Magnetic resonance imaging of the brain revealed increased ventricle size and increased size of a subependymal giant cell astrocytoma at the foramen of Monro, as well as spinal cord metastases of giant cell tumors. Decompressive surgery of the foramen of Monro lesion resulted in temporary resolution of the hydrocephalus. Increased Ki-67 labeling of tumor as well as rare spinal enhancement both possibly indicated malignant features for this entity.
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PMID:Subependymal giant cell astrocytoma with cranial and spinal metastases in a patient with tuberous sclerosis. Case report. 1528 62

The authors report a case of a 13-year-old boy with juvenile pilocytic astrocytoma (JPA) presenting with subarachnoid hemorrhage (SAH). The patient experienced sudden onset of headache, vomiting, and loss of consciousness. Cranial computerized tomography scanning revealed blood within basal cisterns and the third ventricle. Angiography demonstrated normal cerebral vasculature and upward displacement of the bilateral A, segments of the anterior cerebral artery. Magnetic resonance (MR) imaging revealed a chiasmatic/hypothalamic mass with evidence of hemorrhage. The mass was surgically decompressed. Histopathological examination showed evidence of JPA. In all cases of SAH in which there is blood around the third ventricle and a raised A1 segment on angiography, MR imaging should be performed. The presence of a normal sella turcica, as well as indistinct margins between the tumor and the opticochiasmatic apparatus should raise suspicion about the lesion.
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PMID:Juvenile pilocytic astrocytoma presenting with subarachnoid hemorrhage. Case report and review of the literature. 1528 67

In the last 11 years we operated on 20 patients (1.03% of all operated brain tumors) with lateral ventricular masses. Anamnesis lasted from 6 months in the case of epileptic seizures to 6 years when headache was the main symptom of disease only. Tumor was located in the anterior cornu and pars centralis in 15, in the trigonum of lateral ventricle in 2, and in the posterior cornu of the lateral ventricle in 3 cases. 13 tumors were large and in MRI the largest diameter was above 5 cm. Tumors located in the anterior cornu and pars centralis were removed using transcortical (10 cases) or transcallosal approaches (5 times). The tumor of the trigonum of ventricle was removed twice through superior parietal lobulus. Tumors of the posterior cornu were operated on via precuneus in order to save visual fields or through the occipital cortex. In 4 cases after removal of tumor the orifice in the frontal lobe was closed with fibrine glue. We totally removed tumors from lateral ventricles in 85% and subtotally in 15% of all cases. Histopathological examination revealed: astrocytoma anaplasticum in 5 cases, astrocytoma pilocyticum 4, oligodendroglioma 2, oligodendroglioma mixtum 1, papilloma plexus chorioidei 2, cystis epidermalis 2, subependymoma 1, ependymoma 1, pineocytoma 1 and haemangiona arterio-venosum 1. Two patients (10%) with diagnosis of anaplastic astrocytoma died after the operation as a result of ischemia and edema cerebri. During the follow-up examination, where the average time of observation was 3.7 years, 15 patients were found to be in a good condition (GR+MD), 1 patient was severely disabled (SD), 2 patients with anaplastic astrocytoma and pineocytoma died because of enlargement of the remnants of tumors left at first operation in spite of reoperation. Tumors of the lateral ventricle grow slowly and often achieve a large size before their clinical appearance. Most of tumors are accessible for a total or subtotal removal with acceptable morbidity and mortality rate after the operation. Long-term results depend on the size of resection and histopathological investigation.
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PMID:[Surgical treatment of intraventricular tumors]. 1535 29

Astroblastoma is one of the very unusual type of tumors, whose histogenesis has not been clarified. It occurs mainly among children or young adults. Astroblastoma is grossly well-demarcated, and shows histologically characteristic perivascular pseudorosettes with frequent vascular hyalinization. Perivascular pseudorosettes in astroblastoma have short and thick cytoplasmic processes and blunt-ended foot plates. A 15-yr-old girl presented with headache and diplopia for one and a half year. A well-demarcated mass, 9.7 cm in diameter, was found in the right frontal lobe in brain MRI, and it was a well-enhanced inhomogenous mass. Cystic changes of various sizes were observed inside the tumor mass as well as in the posterior part of the mass, but no peritumoral edema was found. Histologically, this mass belongs to a typical astroblastoma, and no sign of anaplastic astrocytoma, gemistocytic astrocytoma or glioblastoma was found in any part of the tumor. Immunohistochemically, the tumor cells showed diffuse strong positivity for glial fibrillary acidic protein, S-100 protein, vimentin and neuron specific enolase, and focal positivity for epithelial membrane antigen and CAM 5.2, while showing negativity for synaptophysin, neurofilament protein, pan-cytokeratin and high molecular weight keratin.
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PMID:Astroblastoma: a case report. 1548 62


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