Turkish Neurosurgery
Challenges in the clinical and radiological differential diagnosis of cerebrovascular events and malignant primary brain tumors: Reports from a retrospective case series
Erdinç Civelek1, Yener Akyuva2, Necati Kaplan3, Furkan Diren1, Osman Boyalı1, Serdar Kabataş1
1University of Health Sciences, Gaziosmanpasa Training and Resarch Hospital, , Department of neurosurgery, İstanbul,
2Mustafa Kemal University, Department of Neurosurgery, Hatay,
3Rumeli University, Reyap Hospital,, Department of Neurosurgery, İstanbul,
DOI: 10.5137/1019-5149.JTN.30371-20.2
Aim:To reveal difficulties in differential diagnosis of some cases of cerebrovascular events (CVE)) and malignant primary brain tumors (MBT) even a multidiciplinary evaluation in Grand rounds.Material and Methods:This study retrospectively analyzed the patient archives from January 2017–January 2020. The records of 572 patients discussed in these meetings were examined. 8 patients having a challenge in differential diagnosis were detected. Results:This study has included 8 cases in which neurology−neurosurgery−neuroradiology clinicians have difficulty differentiating CVE and MBT. In the present study, three patients were evaluated with a preliminary diagnosis of hemorrhagic CVE in the emergency room. Since degradation products of hemoglobin have prevented advanced imaging methods to diagnose in two patients, these patients have been followed closely. The correct diagnosis could be made through the scan performed during control follow-ups The preliminary diagnosis of seven patients was CVE, but they received the MBT diagnosis during the follow-up. One patient was thought to have MBT initially; however, he/she was diagnosed with CVE after an advanced examination and close follow-up.Conclusion:Despite developing medical imaging methods and diagnostic studies, there are still some difficulties in making differential diagnosis of cerebrovascular events and malignant primary brain tumors. İn some patients, further examination and imaging methods may be needed such as MR-spectroscopy (MRI-S), perfusion MR (Per-MRI), Digital substratioangiography (DSA). Despite all these neuroradiological examinations and multidiciplinary evaluation, distinction between CVE and MIT may be difficult, and medicolegal problems may be encountered.
Corresponding author : Necati Kaplan