Cases reported "Brain Neoplasms"

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1/19. Periictal diffusion-weighted imaging in a case of lesional epilepsy.

    PURPOSE: Diffusion-weighted MR imaging (DWI) has been used for the early diagnosis of acute ischemic lesions in humans and in animal models of focal status epilepticus. We hypothesized that DWI may be a sensitive, noninvasive tool for the localization of the epileptogenic area during the periictal period. methods: A periictal DWI study was performed on a 35-year-old patient during focal status epilepticus with repetitive prolonged focal motor seizures originating from a lesion in the right frontal lobe. DWI results were analyzed visually and by calculating apparent diffusion coefficient (ADC) maps. RESULTS: On DWI, a single area of signal increase (decrease in ADC) was found in the region of focal electrocorticographic seizures that was mapped intraoperatively. CONCLUSIONS: Ictal/postictal DWI may be a useful technique for seizure localization in patients with lesional epilepsy.
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2/19. diffusion magnetic resonance imaging: an early surrogate marker of therapeutic efficacy in brain tumors.

    BACKGROUND: A surrogate marker for treatment response that can be observed earlier than comparison of sequential magnetic resonance imaging (MRI) scans, which depends on relatively slow changes in tumor volume, may improve survival of brain tumor patients by providing more time for secondary therapeutic interventions. Previous studies in animals with the use of diffusion MRI revealed rapid changes in tumor water diffusion values after successful therapeutic intervention. methods: The present study examined the sensitivity of diffusion MRI measurements in orthotopic rat brain tumors derived from implanted rat 9L glioma cells. The effectiveness of therapy for individual brain cancer patients was evaluated by measuring changes in tumor volume on neuroimaging studies conducted 6--8 weeks after the conclusion of a treatment cycle. RESULTS: Diffusion MRI could detect water diffusion changes in orthotopic 9L gliomas after doses of 1,3-bis(2-chloroethyl)-1-nitrosourea (BCNU or carmustine) that resulted in as little as 0.2 log cell kill, a measure of tumor cell death. Mean apparent diffusion coefficients in tumors were found to be correlated with and highly sensitive to changes in tumor cellularity (r =.78; two-sided P =.041). The feasibility of serial diffusion MRI in the clinical management of primary brain tumor patients was also demonstrated. Increased diffusion values could be detected in human brain tumors shortly after treatment initiation. The magnitude of the diffusion changes corresponded with clinical outcome. CONCLUSIONS: These results suggest that diffusion MRI will provide an early surrogate marker for quantification of treatment response in patients with brain tumors.
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3/19. Are some memory deficits unique to lesions of the mammillary bodies?

    The role of the mammillary bodies in human memory is still in debate. A recent model of human amnesia proposes similar functions for the mammillary bodies and the hippocampus. But the main evidence for this model comes from animal studies using the delayed non-matching to sample paradigm. We describe a patient who developed a severe memory impairment after surgical removal of a germinoma. Postsurgical high resolution MRI revealed bilaterally shrunken mammillary bodies and an infarct of the left mammillary body. There were no other relevant lesions. Neuropsychological testing showed mildly impaired frontal lobe functions (executive functions, working memory and word fluency), almost intact learning and recognition, but severely impaired free and delayed recall. Experimental investigations revealed a reduced but preserved release of proactive interference and a pronounced impairment of recency and source judgments. We conclude that the mammillary bodies do play a prominent role in human memory, although the role differs slightly from that of the hippocampus.
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4/19. Focal cooling suppresses spontaneous epileptiform activity without changing the cortical motor threshold.

    PURPOSE: Focal cerebral cooling has been shown to reduce epileptiform activity in animals. There are, however, few reports of this phenomenon in humans. methods: Electrocorticography was performed before resection of a right frontal tumor in a patient with partial seizures. Cold saline was applied to the interictal spike focus, and its effect on the epileptiform discharges was observed. RESULTS: Application of cold saline to the spike focus resulted in a transient, complete cessation of spiking. This effect was reproduced with a second application of cold saline. The motor threshold for electrical stimulation remained unchanged during the application of saline. CONCLUSIONS: In this patient with tumor-related epilepsy, focal cooling of the cortex reproducibly abolished interictal epileptiform discharges without changing the motor threshold to electrical stimulation.
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5/19. Concurrent uveoretinitis and pineocytoma in a child suggests a causal relationship.

    Uveoretinitis was observed in a 9-year-old girl 6 months prior to the clinical appearance of a pineal tumour. Surgical removal was not successful but biopsy revealed a parenchymal neoplasm with differentiated pinealocytes and absent mitotic activity. Some of the tumour cells contained S-antigen, rhodopsin, and serotonin. Systemic glucocorticoid therapy followed by radiation therapy caused considerable reduction in size of the tumour and a complete normalisation of all eye symptoms. This report demonstrates for the first time that a pineocytoma can occur together with uveoretinitis in humans. The latter resembles the experimentally induced autoimmune uveoretinitis described in animals. It is speculated that the retinitis might reflect an autoimmune response to S-antigen present in some tumour cells of the pineocytoma.
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6/19. SV40-positive brain tumor in scientist with risk of laboratory exposure to the virus.

    simian virus 40 (SV40) is a dna tumor virus known to induce cancers in laboratory animals. There are numerous reports of the detection of SV40 dna and/or proteins in human malignancies of the same types as those induced by SV40 in animals, including brain cancers. However, known exposure to the virus has not yet been linked directly to cancer development in a specific individual. Here we describe the detection of SV40 sequences in the meningioma of a laboratory researcher who had a probable direct exposure to SV40 and subsequently developed a tumor positive for viral dna sequences indistinguishable from those of the laboratory source. This case suggests a link between viral exposure and tumor development.
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7/19. Subcortical modulation of spatial attention including evidence that the Sprague effect extends to man.

    The Sprague effect is well-established-small tectal lesions restore visual orientation in the hemianopic field of animals with extensive unilateral geniculo-striate lesions. Studies of human midbrain visual functions are rare. This man with a midbrain tumour developed left-neglect through subsequent right frontal damage. Bilateral orientation returned after clear evidence of damage to the superior colliculus contralateral to the cortical lesion (showing the Sprague effect extends to man). Sustained right-neglect developed after probable additional damage to right superior colliculus. The regulation of spatial attention by tecto-pulvinar circuits is discussed, and it is argued that the reduced right tecto-pulvinar activity (consequent to the additional right collicular damage) was offset by over-compensatory increase in thalamic reticular nucleus (TRN) suppression of left pulvinar activity.
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8/19. Are vestibular sensory cells preserved after destruction of Scarpa's ganglion? A study based on metastatic tumors of temporal bone.

    OBJECTIVE: The contribution of nerve fibers to the maintenance of vestibular sensory cells is a controversial issue in previous studies using animals and has not yet been studied in humans. The authors investigated this issue by observing vestibular end organs in the temporal bone of three patients in whom the internal auditory canal was infiltrated with tumor cells, and Scarpa's ganglion cells showed complete degeneration. STUDY DESIGN: Retrospective case review. SETTING: University Hospital, Department of otolaryngology. patients: Three patients with malignant metastatic temporal bone tumors. INTERVENTION: We investigated the preservative state of vestibular sensory hair cells with the Scalpa's ganglion was destructed. MAIN OUTCOME MEASURES: Maintenances of vestibular sensory hair cells. RESULTS: We found that sensory cells were intact despite the severe destruction of Scarpa's ganglion cells in two of the patients. CONCLUSION: The findings suggest that human vestibular sensory cells can be maintained for an indefinite period after denervation.
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9/19. glioblastoma multiforme occurring in a patient following exposure to polychlorinated biphenyls.

    polychlorinated biphenyls have been shown to be carcinogens in animal studies. Because of lipid solubility and lack of biodegradation, they are known to deposit preferentially in fat and nervous tissue. In this report, we describe a 31-year-old male with prolonged polychlorinated biphenyls exposure who developed glioblastoma multiforme. Fat biopsy documented the presence of markedly elevated PCB levels. A co-worker also developed a malignant astrocytoma. The nature of PCBs and their role in human carcinogenesis are discussed. The possibility of an etiologic link between PCBs and brain tumors should be further investigated.
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10/19. Brainstem death.

    A patient with the clinical picture of brain death resulting from brainstem hemorrhage and subsequent infarction is presented. The EEG showed activity similar to what has been described in the cerveau isole animal preparations. Cortical evoked potentials were unobtainable from auditory or somatosensory stimulation, but of unusually high amplitude to flash stimuli. The point is made that a diagnosis of brain death cannot be made on clinical grounds alone when a patient is on life support systems, and the differences between cerebral death, brainstem death and brain death are discussed.
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