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Ganglioglioma

First described by CB Courville in 1930, Ganglioglioma comes from the Greek work 'ganglion' meaning know, and the Greek word glia meaning glue and the Greek word oma meaning tumor. Strung together, the words mean 'glue knot tumor'. Ganglioglioma is a rare type of tumor that originates from nerve cells and develops in the central nervous system. The growth of the tumor and its symptom may vary depending on its exact location and size.


Ganglioglioma accounts for 2% of all primary intracranial tumors and up to 10% of primary cerebral tumors in children. Ganglioglioma can occur anywhere in the brain and rarely in the spine as well. Most Gangliogliomas are located on the sides of the brain by the ears and in children about 70% are located above in a part in the brain known as the tentorium - a membrane that separates an area in the back, lower part of the brain known as cerebellum, from an area in the back, upper part of the brain known as occipital lobes. Ganglioglioma can also occur in the brain stem, located below the cerebellum that controls many important motor, sensory and reflex actions.


Symptoms

The signs and symptoms depend on the location of the tumor and how fast it can spread, depending upon the age of the patient. In those above ages 10-20, symptoms include:


  • Seizures
  • Involuntary muscle movements
  • Decreased awareness of the environment.

If Gangliogliomas appear in the ear lobes, it can lead to seizures and symptoms such as:


  • Loss of awareness
  • Abnormal sensations
  • Feeling of being detached from oneself
  • Involuntary muscle movements

If Gangliogliomas are present in the cerebellum, signs and symptoms include:


  • Impaired motor coordination
  • Headache
  • Buildup of cerebrospinal fluid in the brain

Causes

Gangliogliomas are caused by abnormal glial cells. Glial cells support and maintain other cells. Gangliogliomas are partly made of neurons or nerve cells in various degrees of abnormality. In Gangliogliomas are also found supportive tissue known as stroma, which contain fibers and blood vessels. Fibers are flexible, threadlike objects found outside the cells. In Gangliogliomas are neurons, glial cells and stroma in abnormal shape, size and appearance. The more the cells change in structure, size and appearance; the more harmful the tumor is.


Diagnosis

Initially the seizures associated with Ganglioglioma lead a patient to seek medical help. The doctor uses various techniques to diagnose the cause of the seizures. Pictures of the brain are taken and CT scans done to get clear and detailed pictures. MRI scans are sensitive and specific at detaching a tumor and when contrast is injected into the person's body during the scan. About 50% of Gangliogliomas are detected when contrast is used. MRI scans can also detect if there are any cysts in an abnormal lump, swelling or sac that contains fluid and is covered with a membrane.


But it is not until a sample of the tumor is removed during surgery that it can be tested in a laboratory and definitively stated that it is Ganglioglioma. In a laboratory abnormal neurons are stimulated and the irritation produces a protein called synaptophysin and glial fibrillary acidic protein. There are special stains applied to the neurons in the lab to detect the presence of these proteins. However regular x rays do not help in diagnosing Gangliogliomas as they are best at detecting bones and can only detect if calcium is near the Ganglioglioma.

Gangliogliomas are common before age 20 and about 60% of people who are diagnosed with Ganglioglioma are adolescents and adults younger than age 30. However, even those as young as 2 or as old as 70 have been known to develop Ganglioglioma. It affects equal numbers of males and females. In the US approximately 1 to 2% of brain tumors are Gangliogliomas. About 10% of all primary brain tumors in children are Gangliogliomas.


Treatment

Surgery is most often done to remove Ganglioglioma tumor. After the tumor is removed, radiation therapy is not needed unless the tumor shows signs of growing back, which is rare. Radiation is aimed at tumors to destroy or weaken them. Prognosis of people with Ganglioglioma is excellent as it is easy for surgeons to remove them as they are typically found in one place and can be separated from the brain tissue. Most get cured after surgery and chance of tumor coming back after it has been totally removed is rare.


PET scan

PET - Positron Emission Tomography scan is a non-invasive test that aids in imaging the cellular functions and body tissues. It helps in observing the blood flow, oxygen use, and glucose metabolism. A PET scan is of immense help in the diagnosis of cancer, heart disease and brain disorders. The PET scan has been of particular help in the diagnosis of brain tumors, head and neck cancer and esophageal cancer. Since the PET scan reveals metabolic changes in the cells, it aids in early detection of certain conditions such as epilepsy. A PET scan involves injection of a small amount of radioactive tracer drug such as FDG-18. After an hour when the radioactive tracer has spread to the body, the scan is taken. The tracer emits tiny positively charged particles (positrons) that produce signals. A PET scan produces three-dimensional color images from the images taken by a camera that records the tracer as it travels through the body. It is often combined with a CT scan to study a particular body area. Lactating mothers must not breast feed their babies for a few hours after the PET scan.


Intracranial Hematoma

Head injuries account for approximately 70% of traumatic accident deaths. Intracranial hematoma plays an important role in the death and disability that are associated with head injury. Intracranial hematoma is a serious and possibly a life threatening condition that often requires immediate medical attention. Many patients with intracranial hematoma harbor mass lesions that require emergency decompression. Other causes include brain tumors, liver disease, autoimmune syndromes and bleeding disorders.


The human brain floats within the skull. It is surrounded by cerebrospinal fluid which cushions the brain from the bounces of everyday movements. Sometimes it becomes impossible for the fluid to absorb the force of a sudden blow or a quick stop. Under such situations, the brain may slide forcefully against the inner wall of the skull and get bruised. An intra-cranial hematoma occurs when the blood vessel ruptures between the skull and the brain. The blood leaks between the brain and the skull. This collection of blood, hematoma, which is possibly clotted, compresses the brain tissue. Some hematomas require surgery to remove the blood clot whereas some others can be treated without surgery.


Symptoms of intracranial hematoma include headache, nausea, vomiting, lethargy and slurred speech. The pupils may appear of unequal size. Memory loss is often associated with head trauma. One may even forget that they have suffered a blow. These symptoms of intracranial hematoma may occur either immediately or several weeks or months after a blow has been received in the head.


Injury in the head is the most common cause of intracranial hematoma. Among elderly persons, even a mild head trauma is more likely to cause a hematoma in the brain. Hematoma resulting from injury in the head is classified as:


Subdural hematoma: This occurs when the blood vessels, most often the veins rupture between the brain and the dura mater which is the outermost of three membrane layers that covers the brain. The blood that leaks forms a hematoma. This compresses the brain tissue. The danger here is that if the hematoma keeps growing then there is a progressive decline in consciousness and possible death. The risk of subdural hematoma is greater in people who use aspirin or other anticoagulants regularly. Alcoholics and very young and very old people also stand to be affected by subdural hematoma. All types of subdural hematomas require medical attention as soon as the symptoms become apparent. Other wise permanent brain damage may be the result.


Epidural hematoma: This type of hematoma occurs when the blood vessel, usually the artery, ruptures between the surface of the dura mater and the skull. Morbidity and mortality from epidural hematoma is substantial unless immediate medical attention is given. The cause of epidural hematoma is most of the time road automobile accidents or any other traumatic injuries.


Intraparenchymal hematoma: When blood pools in the white matter of the brain, Intraparenchymal hematoma occurs. There may be multiple severe Intraparenchymal hematomas after a head trauma. Serious brain damage can occur, as the neurons can no longer communicate.

A physician may find it difficult to diagnose intracranial hematoma, as it may not be immediately apparent. It is better to seek medical advice after any significant blow has been received to the head and if the patient has lost consciousness or experiences symptoms such as headache, lethargy, nausea and vomiting. A CT scan or MRI scan is suggested to define the position and size of a hematoma.


After a head injury, doctors use medications such as corticosteroids and diuretics to control the edema in the brain after head injury. Often surgery is required. If the blood clot is localized and there is no excessive clotting, then perforation is made through the skull and the liquid is removed by suction. Large hematomas require opening of a section of the skull to remove blood clots.

It is essential to wear appropriate safety equipment and gadgets during sports, including helmet when riding, motorcycling, horseback riding, skating or doing any other activity that may result in injury to head. Chances of motor vehicle accidents can be minimized by wearing a seat belt.

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Collection of Pages - Last revised Date: November 17, 2019