Cases reported "Brain Neoplasms"

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1/30. Psychosocial reactions of children with cancer. A program for rehabilitation.

    The diagnosis of cancer in children challenges all the skills of the pediatric nurse. She utilizes her basic knowledge of development, family dynamics, and disease process. She explores all the implications of long-term illness. She assesses, plans, implements, and evaluates care for the child and his family. She acts as liaison, teacher, and counselor. She is the advocate for the child and his family. As an active member of the team she is instrumental in the process of rehabilitation for the child, physically and emotionally. She can help the child to live with cancer and assure quality of life in the days granted him.
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2/30. Neuropsychiatric manifestations of a third ventricular colloid cyst.

    A 48-year-old man with no psychiatric history presented with memory disturbances, personality changes, emotional lability and mild paranoia with no evident mood disturbances. A colloid cyst of the third ventricle was discovered and surgically excised.
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3/30. Intensity-modulated stereotactic radiosurgery using dynamic micro-multileaf collimation.

    PURPOSE: The implementation of dynamic leaf motion on a micro-multileaf collimator system provides the capability for intensity-modulated stereotactic radiosurgery (IMSRS), and the consequent potential for improved dose distributions for irregularly shaped tumor volumes adjacent to critical organs. This study explores the use of IMSRS to provide improved tumor coverage and normal tissue sparing for small cranial tumors relative to plans based on multiple fixed uniform-intensity beams or traditional circular collimator arc-based stereotactic techniques. methods AND MATERIALS: Four patient cases involving small brain lesions are presented and analyzed. The cases were chosen to include a representative selection of target shapes, number of targets, and adjacent critical areas. Patient plans generated for these comparisons include standard arcs with multiple circular collimators, and fixed noncoplanar static fields with uniform-intensity beams and IMSRS. Parameters used for evaluation of the plans include the percentage of irradiated volume to tumor volume (PITV), normal tissue dose-volume histograms, and dose-homogeneity ratios. All IMSRS plans were computed using previously established IMRT techniques adapted for use with the BrainLAB M3 micro-multileaf collimator. The algorithms comprising the IMRT system for optimization of intensity distributions and conversion into leaf trajectories of the BrainLab M3 were developed at our institution. The ADAC Pinnacle(3) radiation treatment-planning system was used for dose calculations and for input of contours for target volumes and normal critical structures. RESULTS: For all cases, the IMSRS plans showed a high degree of conformity of the dose distribution with the target shape. The IMSRS plans provided either (1) a smaller volume of normal tissue irradiated to significant dose levels, generally taken as doses greater than 50% of the prescription, or (2) a lower dose to an important adjacent critical organ. The reduction in volume of normal tissue irradiated in the IMSRS plans ranged from 10% to 50% relative to the other arc and uniform fixed-field plans. CONCLUSION: The case studies presented for IMSRS demonstrate significant dosimetric improvements for small, irregularly shaped lesions of the brain when compared to treatments using multiple static fields or standard SRS arc techniques with circular collimators. For all cases, the IMSRS plan yielded a smaller volume of normal tissue irradiated, and/or a reduction in the volume of an adjacent critical organ (i.e., brainstem) irradiated to significant dose levels.
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4/30. Chronic illness in couples: a case for emotionally focused therapy.

    The onset of chronic illness is one of the most pervasive health problems facing North Americans today. Only recently have researchers and clinicians seriously examined chronic physical conditions in the context of close relationships. This article briefly reviews the literature on chronic illness in adult couples. Initially, the focus is on the reciprocal link between close relationships and chronic physical conditions. A number of clinical approaches for working with chronic illness in couples are outlined, a particular case is made for the utility of emotionally focused therapy, and a case study is presented.
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5/30. Gliomatosis cerebri: neurobehavioral and neuropathological observations.

    BACKGROUND: Gliomatosis cerebri is a rare neoplasm in which individual neoplastic cells diffusely permeate the brain; a cohesive tumor mass may appear late in the disease course, or not at all. The diagnosis can be made either at autopsy or premortem by combining biopsy and neuroimaging findings to demonstrate involvement of more than two lobes of the brain. Extensive hemispheric white matter and corpus callosum infiltration is characteristic, with lesser spread to subcortical and cortical gray matter. Whereas this pattern of localization can be predicted to cause significant disturbances of higher function, the neurobehavioral profile of gliomatosis cerebri patients has not been well described. METHOD: Three patients with gliomatosis cerebri had detailed neurobehavioral assessment, and one had neuropsychological testing early in the disease. Neuropathological investigation focused on the localization of the neoplasm, the correlation between extent of myelin and axon damage with tumor cell density, and the histogenesis of the tumor. RESULTS: The patient with neuropsychological testing had impaired executive function and verbal memory retrieval that reflected bifrontal and left temporal white matter tumor involvement seen on neuroimaging. In the other cases, apathy and fatigue progressed to severe dementia in association with bihemispheric white matter infiltration. Myelin and axon stains and myelin stains showed relative preservation of white matter architecture with severity of damage paralleling increased tumor cell density. Immunostaining for TP53 was found in a high percentage of tumor nuclei in two of three cases, suggesting overlapping features between gliomatosis cerebri and diffuse astrocytomas. CONCLUSIONS: Subtle cognitive and emotional alterations antedate the florid dementia that develops later in the course of gliomatosis cerebri. Clinical, neuroimaging, and neuropathological data suggest that white matter is damaged directly by the tumor and its associated mild edema, although infiltration of subcortical and cortical gray matter also occurs to a variable extent. Strong TP53 immunostaining in gliomatosis cerebri suggests a commonality with diffuse fibrillary astrocytomas that also often show TP53 staining. Gliomatosis cerebri can be considered a cause of white matter dementia resulting from preferential neoplastic disruption of white matter tracts.
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6/30. Epileptic kinetopsia: ictal illusory motion perception.

    A 38-year-old woman with a right posterior temporo-occipital brain tumor developed partial seizures with illusory motion perception of environmental objects going from the center to the periphery within her left visual field. Subdural EEG recordings during visual seizures revealed onsets in the right temporo-parieto-occipital junction. Her ictal visual distortion was probably caused by activation of V5, an area involved in motion perception. Given that the tumor location corresponds with the ictal onset in the V5 area, and the semiology of her seizures, this case supports that epileptic dysfunction in V5 can cause illusions of visual motion.
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7/30. Effects of emotional face cueing on line bisection in neglect: a single case study.

    One patient with left neglect (FM) and four right brain-damaged controls were tested on a line bisection task with pictures of neutral and emotional faces as unilateral cues. We thus manipulated the attentional salience of the cues (higher for emotional and lower for neutral faces) while keeping constant their physical dimensions. Our findings showed that left emotional faces were more effective than left neutral faces in reducing bisection errors only in FM. These data indicate that in the neglected hemispace cues bias attention rather than simply altering the perceptual point of balance of the line in the horizontal plane.
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8/30. Fast improvement of verbal memory function after left temporal tumour resection.

    CASE REPORT: A 7-y-old, right-handed girl presented at our clinic with complex partial seizures, behavioural problems and word-finding difficulties. Clinical examination was normal, but electroencephalogram revealed bilateral epileptic discharges in the temporal and paracentral leads. magnetic resonance imaging showed an intracerebral mass in the left mesial temporal lobe in the areas of the gyrus temporooccipitalis medialis and gyrus parahippocampalis. Neuropsychological testing brought to light an above-average general intelligence, but the girl performed below average in verbal memory tests and average in figural memory tests. RESULTS: The tumour was completely removed by surgery. Neuropsychological testing 3 and 11 wk after tumour resection demonstrated above-average verbal learning and memory abilities and improved visual memory. The emotional disturbances, seizures and electroencephalogram abnormalities disappeared completely during the postoperative follow-up. CONCLUSION: After resection of a left temporal brain tumour, the patient was free of seizures, and neuropsychological functions recovered completely within weeks.
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9/30. diffusion-weighted MR imaging of the brain: value of differentiating between extraaxial cysts and epidermoid tumors.

    This study demonstrates the use of diffusion-weighted MR imaging in improving the specificity of the diagnosis of extraaxial brain tumors. Three surgically proved lesions (one arachnoid cyst and two epidermoid tumors) and two nonsurgically proved lesions (arachnoid and ependymal cysts) were evaluated with T1- and T2-weighted spin-echo studies followed by intravoxel incoherent motion (IVIM) MR imaging. The IVIM images of the lesions were displayed as an apparent diffusion coefficient (ADC) image obtained at 0.65 G/cm (maximum gradient b value = 100 sec/mm2) and compared with external oil and water phantoms. The ADC of arachnoid cysts was similar to stationary water whereas the ADC of epidermoid tumors was similar to brain parenchyma, indicating the solid nature and the slower diffusion rate of the epidermoid tumors. Cisternal CSF demonstrated uniformly high ADC, primarily because of bulk flow, which enhanced image contrast. Improved delineation of postsurgical changes was also possible. Our preliminary results show that diffusion-weighted MR imaging can be useful in distinguishing between arachnoid cysts and epidermoid tumors.
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10/30. nursing care of the child with a brain stem glioma.

    The nursing care of the child with a brain stem tumor focuses on supporting the family and the child's adaptation to the physical and emotional problems of an illness with a variable and often fatal course. With the advent of magnetic resonance imaging and stereotaxic biopsy, a more accurate assessment of tumor type, location, and size can be made. Advances in surgery, radiotherapy, and multidrug chemotherapy have affected the course of brain stem tumors even though outcome may remain the same.
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