Gettysburg Medical News
The Clinical View
by P.E. Hoffsten, MD
23 August 2006

BRAIN TUMORS

            In our society, it is not uncommon to hear someone say, “You act so weird I think you must have a brain tumor.”  This is often said in a joking way.  But the day that somebody does have a brain tumor, there is nothing that would be less of a joking matter.

            Recently, a lady came to the clinic for evaluation of dizziness.  I have commented before that the three complaints least likely to lead to a medical diagnosis are dizzy, tired, and weak.  When someone comes in with these symptoms, doctors can do extensive evaluations and it is very unusual that a new treatable diagnosis is made.   However, each patient and each symptom must always be appropriately evaluated and treated with respect. That is what we did with this lady.

            She stated that she was out cutting the grass in her back yard when she suddenly became very dizzy.  Dizziness comes in two broad categories one of which is called vertigo.  With vertigo the person describes the surroundings as going around in a circle; the symptom is present even if the person is sitting still or with their eyes closed.  The second kind of dizziness relates to unsteadiness when the person tries to walk or move.  This type of symptom is not so bad if the person sits still or closes their eyes.  This lady described her situation as not being able to stand or walk because everything seemed so unsteady. She did not indicate that she felt as if she was going around in a circle.  She said that she stumbled into the house with great difficulty.  She stated that someone would have believed that she was drunk but she swore she was not drinking..  When she got into the house, she described hanging onto the kitchen counter until she could get to a chair and sit down.  After about an hour she was able to get up and walk again.  She never fell and she did not become nauseous or vomit.  She did not have any pain in her arms or legs. Her eyes, hearing, and speech all seemed to work normally during this time.  She said that she just could not stand up to walk in a normal manner.

            A detailed neurologic examination in the clinic showed no abnormality when I saw her.  Routine blood tests were done and again there was no abnormality identified.  She said that she felt fine now when I saw her in the clinic but she wondered what had happened.

            Another lady came to the clinic eight years ago because she was developing headaches that she felt were different than headaches that she usually had.  She had been taking headache pills for many years but said now that the headaches that she was having were different.  She wondered what might be wrong.

            A third person called the clinic at about 10:00 am one morning 15 years ago to tell me that he thought he had just had a seizure.  He wasn’t sure but described sitting at a railroad crossing as a train went by.  He said he didn’t remember the end of the train and thinks that he lost consciousness while it was passing.  He said that now he was sitting in his car at the crossing and the train had apparently long gone.  He said that he had a sore tongue and he had wet himself.  He assumed that he must have had a seizure and wondered what to do next.  He was told to pull to the side of the road and an ambulance would come pick him up.

            Each of these people was further evaluated with something called a magnetic resonance scan.  This is a type of examination using magnetic waves to image the person’s body tissues.  It can see tumors very easily especially in the brain.  As you might imagine being told that you have a brain tumor is a terrifying experience.  There are malignant types that are often fatal.  But a more common type in my practice has been benign tumors that have slow limited growth and can be very effectively treated.  Each of the three individuals mentioned above were found to have a benign type of tumor called a meningioma.

           One of these individuals was diagnosed in the past month.  The two individuals that were diagnosed years ago were referred to a neurosurgeon for consideration.  In the “good old days” these types of tumors required surgery and the ability to remove the tumor was often not possible.  However, modern technology has developed a wonderful instrument called a gamma knife. With this instrument, a special type of ray is focused on the bran tumor and it can virtually be “cured” without the head every having to be surgically opened.  Sometimes a second even a third gamma knife treatment may be necessary but the two individuals mentioned above both had one treatment and have remained symptom free ever since.

            The older textbooks of neurology talk about a meningioma being a fatal condition unless it can be surgically removed.  That is certainly not the condition today.  In fact with modern MRI scanners, it has been seen that small meningiomas are found in a large number of individuals accidentally when they are being evaluated for something entirely different.  Eighty percent of these tumors never come to clinical or surgical attention and are instead diagnosed “by accident”.  The rule has become “if it doesn’t bother you, don’t bother it.”  Many of these small tumors that we never even knew about before never have to be treated.

            The lady I mentioned above is now going through the process of meeting with the neurosurgeon, deciding on an appropriate treatment for her problem.  As distressing as the whole situation is, in fact, her long term outlook is really very good just as the other two patients I took care of 8 and 15 years ago have done very well.  Thus, having a brain tumor is a very horrifying diagnosis to hear about if it is your own.  But fortunately, with today’s technology it often can be dealt with very effectively with non-invasive treatments.

            The healthcare professionals as your local clinic are aware of these considerations.  And while we see lots of patients that are tired or dizzy or weak, each patient is given the respect of evaluating their symptoms with an appropriate diagnostic workup and treatment when needed.