Psychiatric disorders and growth of brain tumors

In 49 of 365 clinical and patho-anatomical intracranial tumour cases the tumours were indicated in the anamnesis only by mental disturbances before acute signs of brain pressure appeared. With reference to the relations between the psychopathological syndromes and the types of locations of tumours attention is drawn to factors that may complicate the early detection of tumours.     

Facial myokomias in brain stem tumors]

Four cases of brain-stem tumor were described, in which myokymias were electromyographically derived from the region of several cerebral nerves. An attempt is made to interpret the effects of twitching by reference to the electromyogram. Myokymias are a positive indication of organic brain stem damage. The use subtle techniques of electromyographic examination shows that this muscular hyperkinesis is not so infrequent a symptom as is generally believed.     

The fibrinolytic tissue activity of various brain tumors

In tissue samples of 45 operated astrocytomas and of 45 meningiomas the fibrinolytic and proteolytic activity was determined by means of fibrin-agar-plate-method. In astrocytomas significant higher values of fibrinolysis were found than in the meningiomas. In the course of tumor cell necrosis or as a result of brain damage caused by the operation, proteins inducing fibrinolysis are liberated. In some cases they can lead to localized or generalized disturbances of haemostasis.     

Aphasia syndromes in brain tumors. Clinico-pathological correlations]

A clinica-psychological and pathoanatomical analysis of 40 observations with neoplasms of the brain in the left dominant hemisphere and 4 observations with neoplasms in the right subdominant hemisphere, has been carried out. In 36 cases, a desintegration in the language in a form of aphasia, has been established, while in 4 cases this was not present. In 22 observations the established neuro-psychological syndrome completely indicated and coincided with the localization of the neoplasm in the corresponding part or parts of the brain, in 10 it only partialy coincided, while in 4 cases it did not coincide with the localization of the neoplasm in the brain. The established neuro-psychological syndrome in observations with neoplasms in the right subdominant hemisphere possesses only a tentative topico-diagnostical significance. In conclusion the authors consider that the established syndromes of aphasia in patients with neoplasms of the brain may be of a considerable significance and help in substantiating a precise topical diagnosis.     

Verbal memory abilities of children with brain tumors.

Several critical neuroanatomical structures and pathways for memory performance are located in the third ventricle region. This led us to predict that verbal memory abilities would be more impaired in children treated for third ventricle tumors compared to those treated for cerebellar tumors. Archival data was obtained from 24 pediatric patients with third ventricle region tumors and 18 pediatric patients with cerebellar tumors. Neuroradiological verifications of tumor involvement and hydrocephalus severity (i.e., Evans Index) on preoperative scans and MRIs proximal to the time of the neuropsychological evaluation were conducted. The potential confounds of hydrocephalus severity, seizure medication, age, radiation treatment, and chemotherapy were addressed. Verbal IQ was comparable between tumor groups and in the Average range. The third ventricle region group performed significantly worse on list learning and delayed list recall compared to the cerebellar group. Their mean performance was in the clinically impaired range on both trials. The third ventricle region tumor group performed better than the cerebellar tumor group on Digit Span, a basic repetition, attention span task. These findings support the hypothesis that pediatric patients with third ventricle region brain tumors are more likely to be impaired on verbal recall tasks compared to pediatric patients with cerebellar brain tumors. In contrast, patients who were treated for cerebellar tumors were more impaired on the basic repetition, attention span task compared to patients who were treated for third ventricle tumors. Future studies should examine the specific neuroanatomical structures and pathways that are damaged and may influence differential cognitive impairments in children.     

Attention and memory in children with brain tumors.

The Rey Auditory Verbal Learning Test was utilized to examine attention, learning, and memory abilities in 42 children with cerebellar (N = 18) and third ventricle tumors (N = 24). Children with cerebellar tumors exhibited significant auditory attentional impairments and displayed adequate encoding and retrieval across subsequent learning and memory trials. In contrast, children with third ventricle tumors exhibited average auditory attentional abilities, but they displayed mild encoding deficits across trials 2-5. Furthermore, the third ventricle group's compromised performance on the delayed recall trial and average performance on the delayed recognition trial is suggestive of underlying retrieval deficits.     

Psychiatric symptoms associated with brain tumors: a clinical enigma

Patients in psychiatric settings may present with medical conditions, such as brain tumors, which may or may not be associated with neurological symptoms. In some cases, patients may only have psychiatric symptoms, such as mood changes (depression or mania), psychotic symptoms, panic attacks, changes in personality, or memory difficulties. Brain tumors may be detected in patients at their first presentation to mental health services or sometimes in patients with well-established psychiatric diagnoses. This article presents the case of a 29-year-old woman who was treated for >4 years for posttraumatic stress disorder and borderline personality traits, who developed depressive symptoms and memory difficulties. However, she did not develop any major neurological signs or symptoms. Brain imaging showed the presence of a left thalamic tumor, later confirmed as glioblastoma multiforme. She underwent surgical treatment and radiation therapy. With this we show that in some cases, brain tumors can be neurologically silent and only present atypical psychiatric symptoms. We emphasize the need for neuroimaging studies in a patient with atypical changes in mental status, even without neurological signs or symptoms.     

Combination treatment of malignant brain tumors. Results of initial experiences

First experiences with the combined treatment of malignant gliomas (29 cases) are presented in connection with the results reported in literature. The cytostatic therapy has been carried out according to the modified Israel-Scheme of Heiss et al. Using the combined treatment (resection of tumor, radiotherapy and polychemotherapy) a prolongation of survival time to 55 till 80 weeks is noticeable. The patients observed in our study survived on an average 79,8 weeks (operation and chemotherapy) resp. 94,7 weeks (operation, radiotherapy and chemotherapy). Special problems of the cytostatic therapy of malignant brain tumors are considered, among others in relation to the blood-brain-barrier and the tumorcell-kinetics; a further optimation of therapy is necessary.     

Diagnostic assessment of cerebrospinal fluid protein in brain and spinal tumors

The cerebrospinal fluid of 69 patients with tumors of the brain and the spine was examined for total protein content, IgG concentration, IgG total protein quotient, and electrophoretic protein pattern. There is no specific finding in the case of the central nervous system. At best characteristic constellations may be established.     

Results of combined treatment of malignant brain tumors with various cytostatic protocols

Nowadays best results in the treatment of malignant brain tumors can be obtained with an interdisciplinary combined treatment (operation, radiation, antineoplastic chemotherapy). We treated 83 patients with gliomas after operation with a combined radiation/chemotherapy. Chemotherapy was performed by two different schemas (Israel n = 49, COMP n = 34). Both groups had the same structure concerning the 10 most important prognostic factors. The median survival time was found to be 26.1 months in the Israel-group and 22.8 months respectively in the COMP-group. The number of the long-time survivors is increasing in the COMP-group.     

Neurodevelopmental model of long-term outcomes of adult survivors of childhood brain tumors

Childhood brain tumors and related treatments disrupt the developing brain and have a cascading impact on core cognitive skills and intellectual (intelligence quotient [IQ]) and academic achievement outcomes. Theoretical models for this cascade have been developed based on the literature, but no studies thus far have empirically evaluated the models. The current study aimed to empirically test the two extant models and generate a new data-driven model of the relationships among neurodevelopmental risk factors, core cognitive skills (i.e., processing speed, attention span, working memory), and IQ and achievement outcomes. Fifty-seven adult survivors of childhood brain tumors and fifty-seven demographically matched neurotypical individuals were included in the current study. The average age at brain tumor diagnosis was 8 years, and the average time since diagnosis was 17 years. Three a priori path models tested the hypothesized relationships among variables. Results of the path analyses revealed that the hybrid model best fit the data for both survivors and controls based on all statistical criteria. For survivors, processing speed was the core cognitive skill most widely associated with neurodevelopmental risk factors and outcomes. However, working memory and attention span also had unique contributions to IQ and academic achievement. Processing speed appears to be the central cognitive skill that disrupts the other core cognitive skills of attention span and working memory, and all three make a unique contribution to IQ and academic achievement. This is best demonstrated by a novel neurodevelopmental model that combines components of two earlier untested theoretical models.     

Disorders of higher mentae functions as first symptoms in patients with brain tumors]

It has been established that in 29 (or 36,25%) of examined patients with neoplasms of the brain in the left dominant hemisphere, disturbances in the psychic functions seem to be the first and most early symptoms of the disease. They develop slowly, progressively, or in the form of epileptic language equivalents (in 5% of examined patients). As early symptoms, disturbances in language indicate existance of a brain disease and give cause to suspect a neoplasm, in this way stating the necessity of further examination, and from the other side - in some cases show the localization of the process.     

Cumulative neurological factors associated with long-term outcomes in adult survivors of childhood brain tumors

Prior research has demonstrated the reliability and validity of the Neurological Predictor Scale (NPS) in relation to childhood brain tumor survivor outcomes; however, its use has not been examined in adult long-term survivors. The current study examines the concurrent validity of the NPS with long-term intellectual and adaptive outcomes in adult survivors of childhood brain tumors relative to individual variables alone. A total of 68 adult survivors of childhood brain tumors (M = 24 years old, SD = 4) almost 16 years post diagnosis (SD = 6) completed intellectual evaluations using the Wechsler Abbreviated Scale of Intelligence (WASI). Survivors’ adaptive functioning skills were assessed via informant structured clinical interviews (SIB-R). NPS scores were computed from data acquired from medical records. The NPS was significantly associated with intellectual (R² = 0.208, p < .05) and adaptive outcomes (R² = 0.30, p < .05) over and above individual risk factors. Approximately 18% of long-term survivors were identified as impaired in intellectual outcomes, and 29% were identified as impaired in adaptive functioning in everyday life skills. The NPS quantifies the cumulative effects of treatment and neurological sequelae experienced by both short- and long-term survivors of childhood brain tumors. It is a useful and easy measure to employ in clinical research that focuses on quantifying the neurological risk factors associated with long-term intellectual and adaptive functioning outcomes in adult survivors of childhood brain tumors.     

Correlation between clinical and paraclinical findings in brain tumors in comparison with the operation site

On the basis of clinical material consisting of 147 brain tumors, the authors carry out a comparative investigation involving the site of the ensuing operation to ascertain the accuracy of the clinical and paraclinical diagnoses. Computed tomographic findings were deliberately excluded with the intention of focusing on the accuracy attainable by traditional means. Clinical findings, X-ray examination of the skull, ophthalmological findings, electroencephalographic and echoencephalographic data, nuclear diagnosis, and angiographic findings were all taken into account.