Images
Presentation
Here we present a 29-year old man who presented with progressive weakness of the left leg, bowel and bladder incontinence. [ncbi.nlm.nih.gov]
Entire Body System
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Constitutional Symptom
This case illustrates some of the diagnostic challenges in patients with constitutional symptoms. [ncbi.nlm.nih.gov]
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Arm Pain
We treated a 23-year-old man with a history of progressive neck, shoulder and arm pain, with sensory and motor symptoms in the C7 dermatome. [ncbi.nlm.nih.gov]
Gastrointestinal
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Nausea
A 14-year-old boy had a 12-day history of headache, nausea, and vomiting. Magnetic resonance imaging revealed a tumor in the fourth ventricle. He underwent a posterior median craniotomy, and total removal was achieved. [ncbi.nlm.nih.gov]
Depending on the location, symptoms can include nausea, headaches, vomiting, papilledema, paresthesias, ataxia, spinal pain, and changes in mood and personality. [link.springer.com]
In older children and adults, headache, nausea and vomiting are the most common symptoms. Treatment / Standard of Care Surgery is very important. The neurosurgeon will try to remove as much of the tumour as possible. [braintumour.ca]
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Upper Abdominal Pain
Three days after surgery, the patient complained of upper abdominal pain, nausea, and vomiting. Computed tomography of the abdomen showed dilatation of the stomach. Gastroscopy revealed moderate gastritis without gastric outlet obstruction. [ncbi.nlm.nih.gov]
Neurologic
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Headache
In our illustrative case, the patient had a 2 year history of hypopituitarism, but no headaches or visual disturbance. Preoperatively, the lesion was thought to be a pituitary macroadenoma. [ncbi.nlm.nih.gov]
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Increased Ankle Reflex
ankle reflexes ipsilaterally may occur, as well as flaccid paralysis with loss of reflexes contralaterally Physical findings with myxopapillary ependymomas of the conus and cauda equina may include the following: Presenting symptom is pain in the back [emedicine.com]
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Cognitive Deficit
The rate of gross-total resection has been increased to 85% in some series and 3 year progression-free survival after radiation therapy as high as 75% has been reported along with significant reductions in neurologic, endocrine and cognitive deficits. [ncbi.nlm.nih.gov]
“We watch carefully for signs of brain hemorrhage, such as garbled speech and other cognitive deficits,” says Murphy, “and monitor the lower extremities for swelling, redness, and pain.” [nursing.onclive.com]
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Cerebellar Sign
Tiwari et al. report a 62-year-old woman presenting with recurrent symptoms of gait ataxia and cerebellar signs 6 years following gross total resection of a fourth ventricular subependymoma. [jneuro.com]
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Generalized Seizure
A 22-year-old female presented with generalized seizures. [ncbi.nlm.nih.gov]
Workup
Initial workup revealed multifocal spinal ependymoma which was resected and treated with external beam radiotherapy. [ncbi.nlm.nih.gov]
4th ventricle, symptoms are related to obstruction and subsequently increased intracranial pressure In spinal ependymomas, presentation is typically with sensory deficits (compared with astrocytomas, which tend to present with pain and motor symptoms) Workup [en.wikibooks.org]
Ependymoma 12. 12 MRI • MRI is the diagnostic modality of choice in the workup and follow-up observation of intracranial neoplasms, including ependymoma. • MRI exploits the use of increased water content of many neoplasms. [slideshare.net]
[…] tumors are isointense or slightly hypointense to the surrounding spinal cord on T1-weighted images; most tumors are hyperintense to the spinal cord on T2-weighted images Other diagnostic modalities that may be helpful include the following: EEG See Workup [emedicine.com]
Treatment
Complete resection of the tumor without further additional therapy was the treatment of choice in most cases (63.6%), radiotherapy was considered in 10 cases (13.0%). In 18 reported cases of tcE (23.4%), the treatment was not documented. [ncbi.nlm.nih.gov]
Prognosis
Data reported in the literature show that prognosis is mainly influenced by grade of resection. [ncbi.nlm.nih.gov]
These ependymomas have a bad prognosis, especially in younger kids, where the 5 year survival is about 50%. [pathologystudent.com]
Etiology
We also systematically reviewed previously reported cases and described its potential etiology, clinical presentation, radiologic features, pathology, immunohistochemical analysis, and ultrastructural examinations. [ncbi.nlm.nih.gov]
Etiology They are thought to arise from the ependymal glia of the filum terminale. Location The vast majority are intradural and extramedullary spinal tumors, occurring in the lumbosacral spine involving the filum terminale and/or conus medullaris. [radiopaedia.org]
The third cyst type, dilation of the central canal, is likely reactive in etiology as well, from partial canal obstruction by the tumor. [appliedradiology.com]
Epidemiology
Lurie Children's Hospital between 1985 and 2008, and an additional 360 ependymoma patients identified from the Surveillance Epidemiology and End Results (SEER) database. [ncbi.nlm.nih.gov]
Descriptive epidemiology of malignant and nonmalignant primary spinal cord, spinal meninges, and cauda equina tumors, United States, 2004-2007. Cancer. 2012;118:4220 7. 7. Wippold FJ 2nd, Smirniotopoulos JG, Moran CJ, et al. [doi.org]
Molecular subgroup epidemiology Each molecular subgroup has different epidemiological profile 13 : infratentorial Posterior Fossa A M:F 2:1 age: young children Posterior Fossa B M:F 1:1 age: older children and teenagers supratentorial RELA fusion M:F [radiopaedia.org]
Pathophysiology
Ependymoma: Practice Essentials, Background, Pathophysiology. [online] Available at: [Accessed 30 Aug. 2017]. 6.0 6.1 6.2 6.3 Kilday JP, Rahman R, Dyer S, Ridley L, Lowe J, Coyle B, Grundy R. Pediatric ependymoma: biological perspectives. [physio-pedia.com]
Gross anatomy of ependymoma of the 4th ventricle Pathophysiology: Ependymoma brain tumors are believed to grow in response to special genetic conformations that change normal ependymal cells into tumor producing cells. [brain-surgery.com]
Pollack, IF, Polinko, P, Albright, AL, Towbin, R, Fitz, C 1995 Mutism and pseudobulbar symptoms after resection of posterior fossa tumors in children: incidence and pathophysiology Neurosurgery 37 885 893 PubMed Google Scholar 19. [doi.org]
Prevention
Although protons have the theoretical advantage of a minimal exit dose to the surrounding uninvolved brain tissue, it is unknown whether they have the same efficacy as photons in preventing local recurrence. [ncbi.nlm.nih.gov]
Clinical trials look at new ways to prevent, find and treat cancer. Find out more about clinical trials . [cancer.ca]
Prevention There are no sure ways of preventing ependymomas. [knowcancer.com]