Disease of the week - Meningioma
Susan Sunday, July 3, 2011 at 10:50AM Hi guys
This is actually from the rounds that I attended 2 weeks ago. After procrastination, here is my first entry. Hope you enjoy, and I would definitely love to hear back from many people!
1. Patient Profile
One evening, a pregnant female entered the emergency room complaining of a splitting headache that had been torturing her for a while. After looking at her, it became apparent what was causing her headache - a tumor; about the size of a chicken's egg in the middle of her forehead. The tumor had developed as her pregnancy progressed. Even though the part of her skull in contact with the tumor was crushed, MRI results showed that the tumour has not damaged the frontal cortex area.
The massive tumour is called meningioma - tumour on the meninges. A meningioma can be either malignant or benign; most tumors are known to be benign. Details about the nature of the tumor is not well known up to this date.
2. Cause
Genetic mutations in genes such as MN1 and PTEN have been largely attributed to meningioma. Due to the genetic nature, it is difficult to control the onset of the disorder.
3. Treatment
Generally, radiation therapy or surgical removal is performed. Radiation therapy is effective when the tumour is small or if the tumor cannot be completely removed by surgery alone. In the patient's case, however, because she was pregnant and because her tumor was diagnosed to be more effectively removed via surgery, she took the surgical route.
4. Follow-up
What was especially interesting about the patient is that the tumor developed along with her pregnancy. Upon more reading, I found a study by Kanaan et al. that deals with meningioma in pregnant patients. According to this study, changes in the hormonal balance during pregnancy may contribute to accelerated growth of tumors in pregnant women. In addition, hormonal imbalance may also contribute to increased blood pressure in the cranium which could harm the mother and also the fetus.
This study also mentions that while surgery is a valid option, possibilities of excessive blood loss and infection are some of the main reasons that deter patients from surgical options. However, surgical option should not have any significant impact on the mother or the fetus as long as their conditions are continuously monitored.
After the surgery, the patient no longer suffered from major headaches. Initially, she showed signs of minor cognitive impairments, but the cognitive impairment eventually disappeared after a while. She did not have any complications with her vision, which is a fairly common problem among patients who have undergone meningioma removal surgery. She delivered a healthy baby, who did not seem to have any problems related to meningioma.
5. References
Brigham and Women's Hospital - Department of Neurosurgery and Mayo Clinic
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Reader Comments (2)
Excellent blog. Tweeted. :)
Great job, Susan. Succinct and nice headings. Keep on posting when you get the time!