The Angry Child with Glioma
NATIONAL JOURNAL OF HOMOEOPATHY 2003 Nov / Dec VOL V NO 6.
Dr N L Tiwari
'Nat-mur
Course of Ms F, 13 year old, illness before she was referred
to us: she was admitted to Nair hospital on 7/1/03 with c/o headache since 7
days. She was apparently alright prior to that. She had projectile vomiting when
in school, followed by giddiness and subsequently unconsciousness lasting for 30
minutes. Her headache was generalized, intermittent and throbbing with no
definite aggravating or relieving factors.
On admission there was
No H/O blurring of vision/ diplopia
No H/O sensory or motor deficit
No H/O sphincter involvement
No H/O K/ KC
No H/O BA, Jaundice
Birth history was normal
O/E GC - fair; Pulse 84/min; BP 90/70 mm of Hg
General and systemic examination were essentially normal.
MRI of Brain on 7th Jan 03.
A fairly large ovale heterogeneous predominantly hyperintense lesion is seen on
both T1WI and T2WI involving the superior portion of the left thalamus and
adjoining portion of the septum pellucidum, trigone and corpus callosum. It
measures approximately 4.76 X 2.91 X 2.59 cm in dimensions and causes mass
effect on the left lateral and 3rd ventricles. There is
minimal contra- lateral extension. The lesion causes mild early hydrocephalus.
Heterogeneous signals are seen within the lesion. A few abnormal vascular
channels are also visualized. No skip or satellite lesions are seen.
There is no shift of the mediastinal structures.
The visualized orbits, Para nasal sinuses and calvarium appear unremarkable.
Conclusion:
MRI scan reveals
A large heterogeneous hemorrhagic lesion involving the superior portion of the
left thalamus and adjoining portions of the septum pellucidum, trigone and
corpus callosum. its described above. Possibility of a hemorrhagic neoplasm is
likely. It causes mild early hydrocephalus.
Follow up CT Scan done on 13/1/03
Plain and contrast enhanced scans of brain performed by taking 4mm and 8mm
sections. 3D coronal and sagittal multiplanner reconstruction images given.
Serial Scans reveal:
There is a mixed density enhancing soft tissue lesion seen in the region of the
body of the corpus callosum, involving the body of the left lateral ventricle.
It measures 2.1 x 1.9x 2.0 cms. There is marked enhancement in the periphery of
the lesion. The lesion is pushing the choroid plexus laterally.
There is asymmetric dilatation of the left temporal and occipital horns.
The rest of the neuroparenchyma appears normal.
Dual venous sinuses appear normal.
Impression: Above CT findings are suggestive of:
A neoplasm involving the left lateral ventricle and adjacent body of corpus
callosum.
The following different diagnosis can be considered:
1) Ependymoma.
2) Glioma.
[Co-ordinating Editor: The reduction in size mass is due to the resolution of
haematoma.]
On 18/1/03, Ms F was referred by Dr R. Pt came in lean, thin, supported by
relatives, could walk with difficulty, could not sit, had profound weakness, and
was asked to lie down on examination table. Voice low, lethargy, dull, lying
quietly on examination table but responding to questions.
Her uncle gave the following history:
On 28th Dec 02 she got upset because her younger brother
spoiled her dress (passed stools on it). She started crying loudly, got very
angry, asking her parents to tear off the dress and throw it out. After that she
developed headache, cold and a swollen eye. Next morning, she went to school,
inspite of having headache as she had exams. When she sat in the jeep to go to
school, her headache increased and became severe. She felt giddy, vomited and
became unconscious. Headache was so severe that she started hitting her head on
the wall, pulling her hair and not allowing anyone to touch her head. Constant
nausea. She remained unconscious for four to five hours. She was given IV
Glucose and regained consciousness. Once again severe headache started which was
continuous and she would hardly get relief for two minutes. She had a painful
cry. People listening to her cry would feel sympathy for her. 6th
Jan 03 pain became less. But dull pain persisted with heaviness.
Prior to this attack, she used to complain of pain in the spine after taking
bath. Headaches often but not so severe.
Past History
Typhoid at the age of 3 yr and 10 yr associated with headache and back pain.
On 7th Jan 03 MRI scan head was performed and evening (6
pm) she complained of headache (1am to 2 am). The patient was put on Tab Diamox
1 TDS.
18th Jan 03 the condition of the patient as follows:-
1) Profound weakness cannot walk without support.
2) Severe nausea, cannot eat any thing; takes liquid, which also nauseates.
3) Lying quietly on examination table with knees drawn chest.
4) Dullness. Eyes closed, respond to question with low voice.
Most of the information was collected from the relatives-from grandfather and
maternal uncle. Mother was in Lucknow (UP)
