Delayed Radiation-Induced Stroke Mimics Recurrent Tumor in an Adolescent With Remote History of Low-Grade Brainstem Glioma
This 13-year-old girl was diagnosed with a ponto-medullary brainstem glioma, and following unsuccessful treatment with chemotherapy, she underwent focal photon intensity-modulated radiation therapy that resulted in a favorable response. Ten years later, she presented with acute left hemiplegia and headaches. Magnetic resonance imaging (MRI) at presentation showed a large contrast-enhancing lesion with surrounding vasogenic edema and reduced diffusivity on diffusion-weighted imaging, most concerning for a high-grade secondary malignancy (Fig 1).
Abstract Treatment of neurological diseases using systemic and non-surgical techniques presents a significant challenge in medicine. This challenge is chiefly associated with the condensation and coherence of the brain tissue. The coherence structure of the brain is due to the presence of the blood brain barrier (BBB), which consists of a continuous layer of capillary endothelial cells. The BBB prevents most drugs from entering the brain tissue and is highly selective, permitting only metabolic substances and nutrients to pass through. Although this challenge has caused difficulties for the treatment of neurologic...
A 13-year-old female was diagnosed with a ponto- medullary brainstem glioma and following unsuccessful treatment with chemotherapy, underwent focal photon intensity modulated radiation therapy that resulted in a favorable response. Ten years later, the patient presented with acute onset left-sided hemiplegia and headaches. Magnetic resonance imaging (MRI) at presentation showed a large contrast- enhancing lesion with surrounding vasogenic edema and reduced diffusivity on diffusion- weighted imaging most concerning for a high grade secondary malignancy (Figure 1).
AbstractMany central nervous system diseases currently lack effective treatment and are often associated with defects in microvascular function, including a failure to match the energy supplied by the blood to the energy used on neuronal computation, or a breakdown of the blood–brain barrier. Pericytes, an u nder-studied cell type located on capillaries, are of crucial importance in regulating diverse microvascular functions, such as angiogenesis, the blood–brain barrier, capillary blood flow and the movement of immune cells into the brain. They also form part of the “glial” scar isolating dam...
Conclusions:Stroke-like migraine attacks are difficult to treat and the pathophysiology is unknown. With more sophisticated imaging techniques, a better understanding of this phenomenon will aid in the treatment and prophylaxis of the syndrome with a goal of improving quality of life for this small but slowly growing population.Disclosure: Dr. New has nothing to disclose. Dr. Mirza has nothing to disclose.
Conclusions:Migraine may be a benign cause of CPV, however, a broad spectrum of diseases including tumors, stroke, infections and neurodegenerative disorders may be responsible. Earlier detection of posterior fossa lesions is critical to improve the outcome. Moreover, central positional vertigo/nystagmus could be the very first manifestation of the underlying disease.Central positional nystagmus is often an unrecognized entity. In this series, 3 patients had isolated positional DBN and truncal ataxia as the initial neurologic abnormality, one of them with a CNS neoplasm. Diagnostic clues for central localization are: prese...
CONCLUSION: SMART syndrome may progress from a benign reversible form to a severe and eventually irreversible form. This severe course may also be confused with tumor progression, and lead to permanent disability and inadequate antitumor treatment. Clinicians should be aware of this latter atypical presentation. PMID: 27919464 [PubMed - as supplied by publisher]
CONCLUSION:Infusion of D2C7-IT via CED is safe thus far and encouraging efficacy results are observed. Enrollment is ongoing.
Conclusion: The identification of one or several nonenhancing space-occupying lesions, especially in elderly patients presenting with cognitive impairment, should raise suspicion for the pseudotumoral presentation of CAA-I and lead to T2*-GRE sequences. Perfusion MRI and MRS appear to be useful techniques for the differential diagnosis of this entity.
CONCLUSION: MELAS can mimic more common disorders. The slow onset of her symptoms and the MRI's appearance led to suspicion for neoplasm. This is the first report to our knowledge where MELAS has presented as such. Documentation of this and other unusual presentations of mitochondrial disease is crucial to appropriate diagnosis of the condition.Disclosure: Dr. Rothstein has nothing to disclose. Dr. Haq has nothing to disclose.