Meningioma misdiagnosed as senile dementia

Pre-operative and post-operative cognitive deficits in patients with supratentorial meningiomas

OBJECTIVES

Cognitive deficits caused by extra-axial benign brain tumors like meningiomas and the course of these deficits after surgery is not well known. The aim of the study is to assess the pre-operative and post-operative cognitive functions in patients with meningiomas in the supratentorial compartment.

MATERIALS AND METHODS

In this prospective study, patients with clinico-radiological diagnosis of supratentorial meningioma, operated upon and later confirmed by histopathological examination, were included. The patients were evaluated for cognitive deficits before and after surgery. The various clinical and radiological factors influencing the cognitive status were evaluated.

RESULTS

A total of 57 patients were enrolled into the study. Out of 57, 22 were males and 35 were females. The frontal group had 22 patients, the parietal group had 10 patients, the temporal group had 10 patients, the occipital group had 6 patients, and the suprasellar group had 9 patients. Meningiomas, although extra-axial, caused significant cognitive deficits in 42 patients (73.7%). The highest frequency of cognitive deficits is seen in the frontal and temporal group of meningiomas (90% each). Frontal meningiomas with volume greater than 35 cc and peritumoral edema greater than 40 cc caused a higher frequency of cognitive deficits. Also, patients with raised ICP had significant cognitive deficits. Postoperatively there was a significant improvement in the cognitive functions in the frontal and temporal groups.

CONCLUSION

Meningiomas cause cognitive deficits in 73.7% of patients. Anatomical location of meningioma, elevated ICP, the volume of meningioma and extent of peritumoral edema significantly influence the incidence of cognitive deficits. Post-operatively, the cognitive deficits improve significantly in the frontal and temporal group.

Preoperative and postoperative cognitive functioning in patients with frontal meningiomas

OBJECT

There is presently no specific information available concerning the nature and course of cognitive deficits caused by intracranial meningiomas. In this prospective study the authors examined the cognitive functioning of patients with frontal meningiomas.

METHODS

Fifty-four patients with frontal meningiomas were examined neuropsychologically before and after neurosurgery. The test battery consisted of standardized instruments including those assessing memory, attention, visuoconstructive abilities, and executive functions. The time period between pre-and postoperative assessment ranged from 4 to 9 months. The patients' performance was compared with the results in 54 healthy adults who were also assessed twice by using the same test battery in a period ranging from 4 to 9 months. In addition, the effect on cognition of meningioma lateralization, localization, lesion size, edema, brain compression, time course, and the occurrence of preoperative seizures was analyzed.

CONCLUSIONS

Except in the case of working memory, comparisons of pre- and postoperative assessments of cognition revealed no differences in memory, visuoconstructive abilities, or executive functions, although a postoperative improvement in attentional functions was observed. The results of this study indicate that the surgical removal of frontal meningiomas does not impair patients' cognitive functioning. Furthermore, improvements in attentional functions may occur in these patients.

Intracranial meningiomas: correlation of peritumoral edema and psychiatric disturbances

Patients with proven intracranial meningioma were reexamined for psychiatric morbidity. Distribution according to type of meningioma was as follows: 72% convexity meningiomas and 28% base-of-skull meningiomas. No psychiatric disorders were diagnosed in the nonconvexity group in contrast to 44% in the convexity meningiomas. Among the convexity meningiomas, no difference between right- and left-hemispheric locations was found. Psychiatric comorbidity in the right-hemisphere group was found only in patients with frontal lobe meningiomas. Edema width was measured on all computed tomographic scan slices on which it appeared, and the average of all the slices was calculated. No correlation was found between neurological symptoms and edema severity. A statistically significant correlation was found between edema volume and the presence of coexisting psychiatric disorders, but not between the tumor's mass volume and the psychiatric symptoms.

Reversible dementias

With so many conditions that can manifest in dementia, the question arises as to how extensive an evaluation need be done on the individual patient presenting with dementia. Thorough physical, neurologic, and psychiatric examinations are the cornerstones of the work-up, with special attention paid to the history, use of medications, and mental status of the patient. Laboratory tests recommended by the National Institutes of Health Consensus Conference on Differential Diagnosis of Dementing Diseases include a complete blood count, electrolyte and metabolic screen, thyroid panel, vitamin B12 and folate levels, syphilis serology, urinalysis, chest radiograph and electrocardiogram, and head CT scan. These evaluations are sufficient to diagnose the majority of treatable dementias. Other evaluations including magnetic resonance imaging, electroencephalography, cerebrospinal fluid examination, cerebral blood flow and metabolism measures (rate of cerebral blood flow, single photon emission computed tomography, and positron-emission tomography), and brain biopsy all can be of additional assistance in diagnosing the cause of the dementia when justified by the clinical setting. When the appropriate diagnosis is made, therapy is directed at the primary disorder. Successful treatment of the primary condition may result in stabilization or partial or complete reversal of the cognitive disturbance. In some instances, judicious pharmacologic management of the accompanying behavioral disturbance may be required.

MRI in psychiatry: 731 cases

The frequency of brain pathology found in the 731 patients who underwent MRI scans in the present study was higher than expected on the basis of reports in the literature (Owens et al., 1980). This underlines the value of a simple MRI examination as an effective diagnostic complement in the investigation of patients with psychiatric symptoms that may have an underlying organic basis.