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Intractable vomiting as an early clinical
symptom of cerebrospinal fluid seeding to the fourth ventricle in patients with
high-grade astrocytoma
Fujimura M, Kumabe T, Jokura H, Shirane R, Yoshimoto T, Tominaga T
Department of Neurosurgery, Tohoku University Graduate School of
Medicine, Sendai, Japan.
Object. Cerebrospinal fluid (CSF) seeding of high-grade astrocytoma is
common, but the early clinical symptoms are not well characterized.
Here, we report five patients with disseminated high-grade astrocytoma in the
fourth ventricle region who presented with intractable vomiting prior to the
detection of the metastatic deposits with enhancement.
Patients and Methods. From 1994 to 2000, 133 patients of high-grade
astrocytoma were treated in our institute and were followed up until December
2002.
Follow-up magnetic resonance (MR) imaging was performed in all patients every
2-3 months.
The CSF seeding was defined as leptomeningeal enhancement.
Signs and symptoms of CSF seeding were checked at the monthly outpatient
examination.
Results. Among them, 5 patients aged from 27 to 58 years (mean 43.8
years) with one anaplastic astrocytoma and four glioblastomas showed intractable
vomiting without signs of high intracranial pressure as evaluated by MR imaging
or ocular fundus examination prior to the detection of the fourth ventricle
dissemination.
Fourth ventricle dissemination appeared 1-3 months after vomiting in five
patients.
One patient with glioblastoma received gamma knife radiotherapy for a fourth
ventricle lesion appearing as a high intensity area on T2-weighted imaging
before the appearance of the enhanced nodule, and this lesion was cured.
Four patients died of progression of the fourth ventricle lesion.
Conclusion. Intractable vomiting may be an early clinical symptom of
CSF seeding to the fourth ventricle in patients with high-grade
astrocytoma.
Early detection and immediate radiotherapy for this lesion are recommended to
control fourth ventricle dissemination.
PMID: 15015789 [PubMed - indexed for MEDLINE]
Source: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15015789
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