submitted by:
Daniel J. Brat
Emory University Hospital
Atlanta, Georgia
Over a period of 6 months, a 31-year-old female developed headaches, nausea and vomiting and experienced
short periods of unconsciousness. An MRI scan revealed a homogeneously contrast-enhancing tumor in the
third ventricle, measuring 3 cm in greatest diameter, which appeared to arise in the
hypothalamic/suprasellar region.
submitted by:
Peter C. Burger
Johns Hopkins Hospital
Baltimore, Maryland
A 37-year-old-woman was evaluated two days after a seizure. A large, intra-axial, non-enhancing mass was
found in the left frontal lobe.
submitted by:
Thomas J. Cummings
Duke University Medical Center
Durham, North Carolina
A 1-year-old Caucasian female presented with a seizure. Neurological examination showed no deficits.
Magnetic resonance imaging (MRI) of the brain showed a large cystic lesion with contrast enhancement in
the right temporal lobe. She underwent a right temporal craniotomy and gross total resection of the
lesion, which intraoperatively appeared to have a distinct margin with the surrounding brain. She did
not receive any postoperative chemotherapy or radiation therapy. Two years postoperative she is
seizure-free, has no focal deficits, and has no evidence of tumor recurrence.
submitted by:
Gregory N. Fuller
Anderson Cancer Center
Houston, Texas
In the late summer of 2002 a 71-year-old man with a history of myelodysplasia five months out from a
matched unrelated donor stem cell transplant developed progressively increasing weakness and was noted to
have a fever of 38.3°C. The patient had been receiving regular blood product transfusions for anemia and
thrombocytopenia. He was admitted to an outside hospital for presumed infection and was started on
multiple antibiotics. Following several family-witnessed seizure-like episodes the patient was started
on phenytoin and transferred to MDACC. Upon admission, an EEG showed marked diffuse generalized slowing
that was non-reactive to exogenous stimulation, consistent with severe encephalopathy. An MRI showed
multiple bright signal intensities on T2-weighted and FLAIR sequences throughout the brain stem,
including the medulla, pons and midbrain. Lumbar puncture showed normal glucose with elevated protein
(147 mg per deciliter). A Gram stain for bacteria, India ink preparation for cryptococcus and bacterial
cultures were negative. Serum samples were sent to the CDC for viral pathogen PCR testing. The patient
developed progressive liver failure, attributed to graft-versus-host disease, and became increasingly
obtunded. He died one week after admission and an autopsy was performed.
submitted by:
Anthony T. Yachnis
University of Florida Medical College
Gainesville, Florida
The patient is a 1-year-old male who presented with failure to thrive and recent onset of vomiting. His
weight was in the 10 percentile on admission despite an apparently normal caloric intake. Birth history
was unremarkable. Imaging studies revealed a 3.3 x 2.4-cm contrast-enhancing mass in the region of the
hypothalamus and optic chiasm. A bifrontal craniotomy was performed and extensive internal debulking of
the mass was accomplished by a transventricular approach.
