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Farkas A, Schlakman B, Khan M, Joyner D. Glioblastoma Presenting with Acute Middle Cerebral Artery Territory Infarct. J Stroke Cerebrovasc Dis 2018; 27:e113-e114. [PMID: 29472157 DOI: 10.1016/j.jstrokecerebrovasdis.2018.01.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 01/16/2018] [Accepted: 01/17/2018] [Indexed: 11/30/2022] Open
Abstract
Acute ischemic stroke caused by a malignant mass has been described in the literature in few case reports. We describe an unusual case of acute ischemic middle cerebral artery distribution infarction secondary to glioblastoma.
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Affiliation(s)
- Amy Farkas
- University of Mississippi Medical Center, Department of Radiology.
| | - Bruce Schlakman
- University of Mississippi Medical Center, Department of Radiology
| | - Majid Khan
- University of Mississippi Medical Center, Department of Radiology
| | - David Joyner
- University of Mississippi Medical Center, Department of Radiology
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Rasmussen BK, Hansen S, Laursen RJ, Kosteljanetz M, Schultz H, Nørgård BM, Guldberg R, Gradel KO. Epidemiology of glioma: clinical characteristics, symptoms, and predictors of glioma patients grade I-IV in the the Danish Neuro-Oncology Registry. J Neurooncol 2017; 135:571-579. [PMID: 28861666 DOI: 10.1007/s11060-017-2607-5] [Citation(s) in RCA: 164] [Impact Index Per Article: 23.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2017] [Accepted: 08/20/2017] [Indexed: 01/18/2023]
Abstract
In this national population-based study of glioma, we present epidemiologic data on incidence, demographics, survival, clinical characteristics and symptoms, and evaluate the association of specific indicators with the grade of glioma. We included 1930 patients registered in the Danish Neuro-Oncology Registry (DNOR) from 2009 to 2014. DNOR is a large-scale national population-based database including all adult glioma patients in Denmark. The age-adjusted annual incidence of histologic verified glioma was 7.3 cases pr. 100,000 person-years. High-grade gliomas were present in 85% and low-grade glioma in 15%. The overall male:female ratio was 3:2 and the mean age at onset was 60 years. Data for WHO grade I, II, III and IV glioma showed several important differences regarding age and sex distribution and symptomatology at presentation. The mean age increased with the grade of glioma and males predominated in all grades. Focal deficits were the most frequent presenting symptom, but among patients with glioma, grade II epileptic seizures were the most frequent symptom. Headache was a rare mono-symptomatic onset symptom. At presentation, higher age, focal deficits and cognitive change for <3 months duration, and headache <1 month were significant independent indicators of high-grade gliomas. Younger age and epileptic seizures for more than 3 months were indicative for low-grade gliomas. Survival rates for glioma grade I-IV showed decreasing survival with increasing grade. Glioma grade I-IV showed high diversity regarding several demographic and clinical characteristics emphasizing the importance of individually tailored disease treatments and support.
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Affiliation(s)
- Birthe Krogh Rasmussen
- Department of Neurology, Nordsjællands Hospital, University of Copenhagen, Hillerød, Denmark
| | - Steinbjørn Hansen
- Department of Oncology, Odense University Hospital, 5000, Odense C, Denmark. .,Institute of Clinical Research, University of Southern Denmark, Odense C, Denmark.
| | - René J Laursen
- Department of Neurosurgery, Aalborg University Hospital, Aalborg, Denmark
| | | | - Henrik Schultz
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Bente Mertz Nørgård
- Institute of Clinical Research, University of Southern Denmark, Odense C, Denmark.,Center for Clinical Epidemiology, Odense University Hospital, Odense C, Denmark
| | - Rikke Guldberg
- Institute of Clinical Research, University of Southern Denmark, Odense C, Denmark.,Center for Clinical Epidemiology, Odense University Hospital, Odense C, Denmark
| | - Kim Oren Gradel
- Institute of Clinical Research, University of Southern Denmark, Odense C, Denmark.,Center for Clinical Epidemiology, Odense University Hospital, Odense C, Denmark
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Russo M, Villani V, Taga A, Genovese A, Terrenato I, Manzoni GC, Servadei F, Torelli P, Pace A. Headache as a presenting symptom of glioma: A cross-sectional study. Cephalalgia 2017; 38:730-735. [DOI: 10.1177/0333102417710020] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective The objective of this study was to analyse the prevalence and the clinical features of headache as a presenting symptom of glioma. Methods We interviewed 527 consecutive adult patients with histologically confirmed glioma, admitted to the Regina Elena National Cancer Institute between 2010 and 2015. We defined four headache phenotypes: Tension-type-like headache (TTH), migraine-like headache, worsening of a pre-existing headache (WPH) and classic brain tumour headache (BTH). Logistic regression analysis was carried out to investigate potential risk factors for headache at presentation of glioma. Results 12.5% (n = 66) of patients with glioma indicated headache as a presenting symptom of their disease. Of these, 31 patients (47%) had TTH, while BTH and WPH were reported by 28 (42%) and seven (11%) patients, respectively. We did not find any case of migraine-like headache. Infratentorial ( p = 0.038) and right-sided tumours ( p = 0.013) were more frequently associated with the presence of headache at onset. Patients with TTH were older than patients with BTH and WPH ( p = 0.035). BTH was less frequently associated with other neurological signs ( p < 0.0001). The multivariate logistic regression analysis showed the localization of the brain tumour in the left hemisphere to be a protective factor for the development of headache. Conclusions Our study includes a very large series of patients with glioma, providing a description of headache phenotype at first presentation of disease and investigating possible factors that may influence the clinical features of headache.
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Affiliation(s)
- Marco Russo
- Neurology Unit, Arcispedale Santa Maria Nuova-IRCCS, Reggio Emilia, Italy
- Department of Clinical and Experimental Medicine, University of Parma, Parma, Italy
| | - Veronica Villani
- Neuro-Oncology Unit, Regina Elena National Cancer Institute, Rome, Italy
| | - Arens Taga
- Headache Centre, Department of Clinical and Experimental Medicine, University of Parma, Parma, Italy
| | - Antonio Genovese
- Headache Centre, Department of Clinical and Experimental Medicine, University of Parma, Parma, Italy
| | - Irene Terrenato
- Biostatistical Unit, Regina Elena National Cancer Institute, Rome, Italy
| | - Gian Camillo Manzoni
- Headache Centre, Department of Clinical and Experimental Medicine, University of Parma, Parma, Italy
| | - Franco Servadei
- Emergency Neurosurgery Unit, Arcispedale Santa Maria Nuova-IRCCS, Reggio Emilia, Italy
- Neurosurgery Neurotraumatology Unit, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Paola Torelli
- Headache Centre, Department of Clinical and Experimental Medicine, University of Parma, Parma, Italy
| | - Andrea Pace
- Neuro-Oncology Unit, Regina Elena National Cancer Institute, Rome, Italy
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Burks JD, Bonney PA, Glenn CA, Conner AK, Briggs RG, Ebeling PA, Toho LC, Sughrue ME. Symptom resolution in infiltrating WHO grade II-IV glioma patients undergoing surgical resection. J Clin Neurosci 2016; 31:157-61. [PMID: 27394379 DOI: 10.1016/j.jocn.2016.03.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Accepted: 03/08/2016] [Indexed: 11/19/2022]
Abstract
Past studies of morbidity in patients with infiltrating gliomas have focused on the impact of surgery on quality of life. Surprisingly, little attention has been given to the rate at which the presenting symptoms improve after surgery, even though this is often the patient's first concern. This study is an initial effort to provide useful information about symptom resolution and factors predicting persistence of symptoms in glioma patients who undergo surgery. We conducted a retrospective analysis on patients who underwent surgery for World Health Organization (WHO) grade II-IV astrocytoma/oligodendroglioma/oligoastrocytoma at our institution. All patients were seen 2-4months postoperatively, and asked about the persistence of symptoms they experienced preoperatively. Symptoms reported in clinic were assessed against symptoms reported prior to surgery. Our study includes 56 consecutive patients undergoing surgery for gliomas. Of patients who experienced symptoms initially, headache resolved in 18/27 postoperatively, weakness resolved in 8/14 postoperatively, altered mental status resolved in 8/12 postoperatively, vision problems resolved in 7/11 postoperatively, nausea resolved in 5/7 postoperatively, and ataxia resolved in 4/5 postoperatively. Headache was more likely to resolve in patients with frontal or temporal tumors (p=0.02). Preoperative Karnofsky Performance Scale (KPS) of 70 or less was associated with longer postsurgical hospital stay (p<0.01). Younger patients were more likely to experience a resolution of altered mental status (p=0.04). Our analysis provides data regarding the rate at which surgery alleviates patient symptoms and considers variables predicting likelihood of symptom resolution. Some patients will experience symptom resolution following resection of WHO grade II-IV gliomas in the months following surgery.
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Affiliation(s)
- Joshua D Burks
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA
| | - Phillip A Bonney
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA
| | - Chad A Glenn
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA
| | - Andrew K Conner
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA
| | - Robert G Briggs
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA
| | - Peter A Ebeling
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA
| | - Lucas C Toho
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA
| | - Michael E Sughrue
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA; Oklahoma Comprehensive Brain Tumor Center, University of Oklahoma Health Sciences Center, 1000 N. Lincoln Blvd., Suite 4000, Oklahoma City, OK, USA.
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Fekete B, Werlenius K, Örndal C, Rydenhag B. Prognostic factors for glioblastoma patients--a clinical population-based study. Acta Neurol Scand 2016; 133:434-41. [PMID: 26358197 DOI: 10.1111/ane.12481] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/18/2015] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To address in a retrospective and population-based study prognostic factors for survival time after diagnosis and surgery for glioblastoma multiforme (GBM). MATERIAL AND METHODS During the study period, 430 patients were identified at the multidisciplinary team conferences as newly diagnosed GBM, 201 of these were considered not to benefit from surgery, and thus, a total of 229 consecutive adult patients with GBM were operated between January 2004 and December 2008 at Sahlgrenska University Hospital and were retrospectively analyzed. Potential predictors of survival were statistically analyzed using Poisson regression models. RESULTS Median survival was 0.73 years. Multivariable analysis showed the following factors to positively influence survival: younger age at surgery, secondary tumor genesis, unifocal tumor location (vs multifocal), resection (vs biopsy only), radiotherapy, and combination of radiotherapy and chemotherapy. CONCLUSION This population-based study supports the importance of surgery instead of biopsy only, followed by radiotherapy and chemotherapy, a finding which has also been stated in earlier non-population-based reports. However, it is obvious that the solution is not just surgical radicality followed by optimal oncological treatment. It is of great importance to seek further subclassifications, biomarkers, and new treatment modalities to make a significant change in survival for individuals.
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Affiliation(s)
- B. Fekete
- Department of Clinical Neuroscience and Rehabilitation; The Sahlgrenska Academy; Institute of Neuroscience and Physiology; University of Göteborg; Göteborg Sweden
| | - K. Werlenius
- Department of Oncology; Sahlgrenska University Hospital; The Sahlgrenska Academy; University of Göteborg; Göteborg Sweden
| | - C. Örndal
- Department of Pathology; Sahlgrenska University Hospital; The Sahlgrenska Academy; University of Göteborg; Göteborg Sweden
| | - B. Rydenhag
- Department of Clinical Neuroscience and Rehabilitation; The Sahlgrenska Academy; Institute of Neuroscience and Physiology; University of Göteborg; Göteborg Sweden
- Department of Neurosurgery; Sahlgrenska University Hospital; The Sahlgrenska Academy; University of Göteborg; Göteborg Sweden
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Chen JR, Xu HZ, Yao Y, Qin ZY. Prognostic value of epidermal growth factor receptor amplification and EGFRvIII in glioblastoma: meta-analysis. Acta Neurol Scand 2015; 132:310-22. [PMID: 25846813 DOI: 10.1111/ane.12401] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/04/2015] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Epidermal growth factor receptor (EGFR) gene amplification and the EGFRvIII mutation may have prognostic value in patients with glioblastoma. This meta-analysis was to determine whether EGFR gene amplification or the EGFRvIII mutation are predictors of survival in patients with glioblastoma and anaplastic astrocytoma. MATERIALS AND METHODS Medline, the Cochrane Central Register of Controlled Trials, EMBASE, and Google Scholar databases were searched until July 31, 2014. Studies were selected for inclusion in the analysis if they included patients with anaplastic astrocytoma and/or glioblastoma, EGFR and/or EGFRvIII mutation status was reported, and overall survival (OS) data were reported. RESULTS Of 113 articles initially identified, only eight contained data with respect to the outcome of interest and were included in the meta-analysis. The number of cases ranged from 14 to 268, and the majority of patients were 60 or more years of age. There was no significant difference in OS between EGFR amplification-positive and EGFR amplification-negative glioblastoma patients (pooled hazard ratio [HR] = 1.101, 95% confidence interval [CI] 0.845, 1.434, P = 0.475) or anaplastic astrocytoma patients (pooled HR = 1.455, 95% CI 0.852, 2.482, P = 0.169). There was no significant difference in OS between EGFRvIII-positive and EGFRvIII-negative glioblastoma patients (pooled HR = 1.321, 95% CI: 0.881-1.981, P = 0.178). Significant heterogeneity existed between the studies, and the significance changed when the analysis was performed with studies removed in turn. CONCLUSIONS There is insufficient evidence that either EGFR amplification or the EGFRvIII mutation has prognostic value in patients with glioblastoma.
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Affiliation(s)
- J.-R. Chen
- Department of Neurosurgery; Huashan Hospital Shanghai Medical College; Fudan University; Shanghai China
| | - H.-Z. Xu
- Department of Neurosurgery; Huashan Hospital Shanghai Medical College; Fudan University; Shanghai China
| | - Y. Yao
- Department of Neurosurgery; Huashan Hospital Shanghai Medical College; Fudan University; Shanghai China
| | - Z.-Y. Qin
- Department of Neurosurgery; Huashan Hospital Shanghai Medical College; Fudan University; Shanghai China
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