ABSTRACT
Tumefactive demyelinating (TDL) lesions are focal zones of demyelination in the central nervous system and they often mimic the neuroimaging features of an intraxial neoplasm. In this report we describe the clinical, neuroimaging and neuropathological features of six cases of TDL. Only in two patients the neuroimaging features in MRI (magnetic resonance imaging) scans were suggestive of TDL while in the other four cases a diagnosis of glioma was suggested. In order to establish a confirmatory diagnosis neuronavigation/stereotactic biopsy was undertaken and the diagnosis of TDL was established in all six cases at histopathology. Two out of six patients did not respond to the conventional corticosteroid therapy and they were treated with plasma exchange. It is being concluded that neuronavigation biopsy, though provide only a small amount of tissue, and is extremely useful in making the diagnosis of TDL.
Subject(s)
Adolescent , Adult , Biopsy/methods , Brain Stem Neoplasms/diagnosis , Brain Stem Neoplasms/drug therapy , Brain Stem Neoplasms/pathology , Child , Demyelinating Diseases/diagnosis , Demyelinating Diseases/drug therapy , Demyelinating Diseases/pathology , Humans , Neuroimaging/methods , Young AdultABSTRACT
The study analyses 111 patients of brain stem glioma; seen in neurosurgery Dept., AIIMS, N. Delhi, India, from Jan '83 to March '97; 60% of the patients were under the age of 15 years, with two peaks in age distribution, 6-10 years & 36-45 years & there was slight male preponderance in all age groups. Most common site of tumour was pons both in adults & children. Pyramidal & cerebellar signs were more frequently seen in children. Duration of symptoms was usually less than six months (in 65.5% of cases). Surgical management was attempted in 72 patients with post of radiotherapy & chemotherapy, rest of the 39 cases were treated with radiotherapy, chemotherapy & antitubercular treatment (if indicated). Improvement was seen in 30% patients postoperatively. Outcome was better in patients who were treated surgically. Astrocytoma was most common histological diagnosis (62%) & glioblastoma was not uncommon & was seen in 10 (13.8%) cases.] We conclude that the patients with brainstem glioma can be helped by surgical decompression, followed by adjuvant radiotherapy & chemotherapy.