Intraventricular Glioblastoma Multiforme with the Pneumographic Characteristics of Intraventricular Epidermoids

Publisher Website
Google Scholar
Abstract
In 1936, Krieg (5) in Germany first described the pneumographic appearance of intraventricular epidermoids, reporting two cases. The following year, Dyke and Davidoff (1) in America independently reported a similar case. The original communications were brief and factual. They merely recorded the findings and suggested that these data might prove helpful in the diagnosis of future cases. The encephalograms published by Dyke and Davidoff showed numerous bizarre globular and linear collections of air in the region of the island of Reil, the right temporal lobe, and the posterior parts of the frontal lobes. This unusual configuration was thought to be due to the collection of air between folds of the tumor surface. Subsequently, a number of isolated case reports appeared in the literature, describing similar pneumographic findings (2, 3, 4, 6). More recently, a few papers (3, 4) have been published implying that this picture is characteristic and pathognomonic of intraventricular epidermoid tumors. An analysis of the gross pathological findings and the pneumograms suggested that the latter claim was probably too pretentious. It seemed more likely that any large, bulky intraventricular tumor with an irregular surface could produce an identical roentgen pattern. A short time thereafter the opportunity to prove this hypothesis presented itself in the form of a patient with a large intraventricular glioblastoma multiforme. Case Report C. O. B., a 69-year-old white female, was admitted to the hospital on Oct. 26, 1948, because of stupor of two to three weeks duration. A month prior to admission, headache had developed, alternately frontal, occipital, and at the vertex. Two weeks later, she became confused, and shortly thereafter began to lose the trend of her speech. On one occasion she stated that she was able to see only half of a long word. Within two or three days, she became progressively more difficult to arouse and complained of tenderness at the vertex. Her expression became dull and she could speak only single words. However, she would brighten up occasionally when her name was mentioned. The significant physical findings were a two-plus bilateral papilledema with venous engorgement, hypersensitivity to painful stimuli in all extremities, decreased hand grip on the right, positive abdominal reflexes, and hyperactive bilateral equal patellar and Achilles reflexes. Station, gait, co-ordination and fine sensitivity could not be tested. The clinical impression was left frontal-lobe tumor with possible deep extension. Routine roentgenograms of the skull showed decalcification of the dorsum sella. On Oct. 27, a ventriculogram was obtained. The right lateral ventricle was tapped and 60 c.c. of slightly xanthochromic fluid were removed. The left ventricle was then tapped, but no fluid could be obtained after the initial drop. Examination of the ventricular fluid showed non-protein nitrogen 47 mg. per cent and a colloidal gold curve of 2233321000.

This publication has 0 references indexed in Scilit: