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Suggest Treatment For Mass Infiltrating The Corpus Callosum
Question: I need to know what to do with this information. Does it require surgery? or what can be used to decompress the brain?
Here is the information stated below
There is a 5.3 x 5.0 x 4.5 cm spherical mass (space occupying lesion) in the right half of the brain. It is showing characteristics of central dead tissue surrounded by peripheral areas of tissue showing active blood flow. It is causing increase in pressure inside the head and this is seen as the left brain being compressed by the spherical mass accompanied with swelling (oedema) of surrounding brain. A midline shift of 0.4 mm is the upper limit of normal and in this scan we find the brain is shifted 1.29 cm off the midline to the left side, and is critical for the patient.
It is also mentioned that the mass is infiltrating into the corpus callosum, as area integrating the right and left part of brain and very important for normal brain function.
With this information, the first possibility is a high grade malignancy of brain (GBM) and this is a very aggressive cancerous tumor.
The other possibilities mentioned are an infection abscess or a white blood cell related cancer involving the brain (Primary CNS lymphoma).
In the given circumstances, the patient needs emergency care and decompression of the increased brain pressure to save his life. The findings also have to be analysed in context to the symptoms of the patient course of illness. If it is indeed a cancer then the treatment is difficult
Here is the information stated below
There is a 5.3 x 5.0 x 4.5 cm spherical mass (space occupying lesion) in the right half of the brain. It is showing characteristics of central dead tissue surrounded by peripheral areas of tissue showing active blood flow. It is causing increase in pressure inside the head and this is seen as the left brain being compressed by the spherical mass accompanied with swelling (oedema) of surrounding brain. A midline shift of 0.4 mm is the upper limit of normal and in this scan we find the brain is shifted 1.29 cm off the midline to the left side, and is critical for the patient.
It is also mentioned that the mass is infiltrating into the corpus callosum, as area integrating the right and left part of brain and very important for normal brain function.
With this information, the first possibility is a high grade malignancy of brain (GBM) and this is a very aggressive cancerous tumor.
The other possibilities mentioned are an infection abscess or a white blood cell related cancer involving the brain (Primary CNS lymphoma).
In the given circumstances, the patient needs emergency care and decompression of the increased brain pressure to save his life. The findings also have to be analysed in context to the symptoms of the patient course of illness. If it is indeed a cancer then the treatment is difficult
Brief Answer:
Surgery is needed in this case.
Detailed Answer:
Hi,
Thank you for posting your query.
I have noted the MRI brain findings.
The patient needs surgery, as early as possible. There are two aims of the surgery:
1. Confirmation of the diagnosis- as you noted in MRI report, there are various possibilities, including cancer and infection. Among cancer also, there are several possibilities such as glioblastoma multiforme, central nervous system lymphoma, etc. After surgery, the tissue would be sent for pathological examination, which would confirm the diagnosis. Confirmation of diagnosis would also help in planning the treatment.
2. Relief of mass effect- there is mass effect due to tumor as well as swelling. Surgical removal of full or part of mass lesion would help in relieving the pressure from the normal brain tissue, and increase in chances of survival.
If there is a delay in surgery, steroids such as dexamethasone should be started.
I hope my answer helps. Please get back if you have any follow up queries or if you require any additional information.
Wishing you good health,
Dr Sudhir Kumar MD (Internal Medicine), DM (Neurology) XXXXXXX Consultant Neurologist
Apollo Hospitals, XXXXXXX XXXXXXX
Click on this link to ask me a DIRECT QUERY: http://bit.ly/Dr-Sudhir-kumar
My BLOG: http://bestneurodoctor.blogspot.in
Surgery is needed in this case.
Detailed Answer:
Hi,
Thank you for posting your query.
I have noted the MRI brain findings.
The patient needs surgery, as early as possible. There are two aims of the surgery:
1. Confirmation of the diagnosis- as you noted in MRI report, there are various possibilities, including cancer and infection. Among cancer also, there are several possibilities such as glioblastoma multiforme, central nervous system lymphoma, etc. After surgery, the tissue would be sent for pathological examination, which would confirm the diagnosis. Confirmation of diagnosis would also help in planning the treatment.
2. Relief of mass effect- there is mass effect due to tumor as well as swelling. Surgical removal of full or part of mass lesion would help in relieving the pressure from the normal brain tissue, and increase in chances of survival.
If there is a delay in surgery, steroids such as dexamethasone should be started.
I hope my answer helps. Please get back if you have any follow up queries or if you require any additional information.
Wishing you good health,
Dr Sudhir Kumar MD (Internal Medicine), DM (Neurology) XXXXXXX Consultant Neurologist
Apollo Hospitals, XXXXXXX XXXXXXX
Click on this link to ask me a DIRECT QUERY: http://bit.ly/Dr-Sudhir-kumar
My BLOG: http://bestneurodoctor.blogspot.in
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thanks for getting back to me
please can you tell me what type steroids to get incase of delay surgery? i know you mentioned dexamethasone , but is there any other type I can get?
please can you tell me what type steroids to get incase of delay surgery? i know you mentioned dexamethasone , but is there any other type I can get?
Brief Answer:
Dexamethasone is better.
Detailed Answer:
Thank you for getting back.
The purpose of using steroids here is to reduce the brain swelling and thus the mass effect. Dexamethasone injections do it the best. The other alternative is methylprednisolone injections.
Other steroids such as prednisolone tablets have much weaker anti brain-swelling effect.
Best wishes,
Dr Sudhir Kumar MD DM (Neurology)
Dexamethasone is better.
Detailed Answer:
Thank you for getting back.
The purpose of using steroids here is to reduce the brain swelling and thus the mass effect. Dexamethasone injections do it the best. The other alternative is methylprednisolone injections.
Other steroids such as prednisolone tablets have much weaker anti brain-swelling effect.
Best wishes,
Dr Sudhir Kumar MD DM (Neurology)
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
thank you, will have that in mind.
I just want to ask is it only through surgery the tissue can be obtained?
I just want to ask is it only through surgery the tissue can be obtained?
Brief Answer:
Yes.
Detailed Answer:
Thank you for getting back.
The only method of obtaining the tissue is through surgery.
Surgery can be done in two ways:
1. Biopsy of the lesion- a minor surgery done only to obtain a small amount of tissue so as to confirm the diagnosis.
2. Major surgery- where in addition to confirming the diagnosis, a significant amount of the mass is also removed, so as to avoid the damage due to mass effect and midline shift.
Best wishes,
Dr Sudhir Kumar MD DM (Neurology)
Yes.
Detailed Answer:
Thank you for getting back.
The only method of obtaining the tissue is through surgery.
Surgery can be done in two ways:
1. Biopsy of the lesion- a minor surgery done only to obtain a small amount of tissue so as to confirm the diagnosis.
2. Major surgery- where in addition to confirming the diagnosis, a significant amount of the mass is also removed, so as to avoid the damage due to mass effect and midline shift.
Best wishes,
Dr Sudhir Kumar MD DM (Neurology)
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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