Delayed cerebral ischemia (DCI) due to post-brain tumor resection vasospasm is an often unrecognized yet debilitating complication. We present a patient with DCI after the resection of glioblastoma multiforme (GBM). T...Delayed cerebral ischemia (DCI) due to post-brain tumor resection vasospasm is an often unrecognized yet debilitating complication. We present a patient with DCI after the resection of glioblastoma multiforme (GBM). To our knowledge, this is the first report on DCI after GBM resection. A 52-year-old female patient with headache for one month underwent subtotal resection of a left temporal GBM encasing the proximal middle cerebral artery (MCA). She was well during the immediate postoperative period but developed right upper limb dense monoparesis on postoperative day four with computed tomographic angiography confirming left MCA vasospasm. Symptoms were significantly alleviated with weeklong hypertensive therapy and nimodipine administration;however they recurred soon after cessation of treatment. A high index of clinical suspicion is needed for the diagnosis of post-tumor resection DCI. Any new postoperative neurological deficit that cannot be explained by hemorrhage, seizures or infection should be expeditiously investigated by angiography or transcranial Doppler sonography. Prompt initiation of hypertensive and nimodipine therapy can possibly reverse neurological deficit. Treatment should be guided by Doppler, angiographic or perfusion imaging studies and not by clinical improvement alone.展开更多
Different brain tumors of distinct histology can co-exist in the setting of phakomatoses or as a complication of radiotherapy. In the absence of these predisposing factors, this phenomenon is uncommon. When the lesion...Different brain tumors of distinct histology can co-exist in the setting of phakomatoses or as a complication of radiotherapy. In the absence of these predisposing factors, this phenomenon is uncommon. When the lesions are in close proximity they are described as collision tumors and are extremely rare. A 58-year-old woman presented with persistent headache and cognitive decline for three months. Magnetic resonance imaging revealed a tumor arising from the atrium of the left lateral ventricle with heterogeneous contrast enhancement. This intraventricular lesion was adjacent to another extensive infiltrating tumor of the basal cisterns. Operative findings revealed a vascular ventricular tumor and gross total resection was achieved. An adjacent avascular basal cistern tumor with a pearly white sheen was encountered and partial excision was performed. The histopathological diagnosis was central neurocytoma and epidermoid tumor. There is only one documented description of a central neurocytoma co-existing with a tumor of different pathology. To our knowledge, this is the first reported collision tumor case involving central neurocytoma. Since the incidence of both lesions co-existing juxtaposed is extremely low, a chronic oncogenetic inflammatory process stimulated by the epidermoid tumor to the subventricular region is suggested. Other mechanisms for tumor collision are discussed and we suggest a classification system for this rare association to reflect their pathogenesis.展开更多
文摘Delayed cerebral ischemia (DCI) due to post-brain tumor resection vasospasm is an often unrecognized yet debilitating complication. We present a patient with DCI after the resection of glioblastoma multiforme (GBM). To our knowledge, this is the first report on DCI after GBM resection. A 52-year-old female patient with headache for one month underwent subtotal resection of a left temporal GBM encasing the proximal middle cerebral artery (MCA). She was well during the immediate postoperative period but developed right upper limb dense monoparesis on postoperative day four with computed tomographic angiography confirming left MCA vasospasm. Symptoms were significantly alleviated with weeklong hypertensive therapy and nimodipine administration;however they recurred soon after cessation of treatment. A high index of clinical suspicion is needed for the diagnosis of post-tumor resection DCI. Any new postoperative neurological deficit that cannot be explained by hemorrhage, seizures or infection should be expeditiously investigated by angiography or transcranial Doppler sonography. Prompt initiation of hypertensive and nimodipine therapy can possibly reverse neurological deficit. Treatment should be guided by Doppler, angiographic or perfusion imaging studies and not by clinical improvement alone.
文摘Different brain tumors of distinct histology can co-exist in the setting of phakomatoses or as a complication of radiotherapy. In the absence of these predisposing factors, this phenomenon is uncommon. When the lesions are in close proximity they are described as collision tumors and are extremely rare. A 58-year-old woman presented with persistent headache and cognitive decline for three months. Magnetic resonance imaging revealed a tumor arising from the atrium of the left lateral ventricle with heterogeneous contrast enhancement. This intraventricular lesion was adjacent to another extensive infiltrating tumor of the basal cisterns. Operative findings revealed a vascular ventricular tumor and gross total resection was achieved. An adjacent avascular basal cistern tumor with a pearly white sheen was encountered and partial excision was performed. The histopathological diagnosis was central neurocytoma and epidermoid tumor. There is only one documented description of a central neurocytoma co-existing with a tumor of different pathology. To our knowledge, this is the first reported collision tumor case involving central neurocytoma. Since the incidence of both lesions co-existing juxtaposed is extremely low, a chronic oncogenetic inflammatory process stimulated by the epidermoid tumor to the subventricular region is suggested. Other mechanisms for tumor collision are discussed and we suggest a classification system for this rare association to reflect their pathogenesis.
