Antti Servo

Atypical and anaplastic meningiomas: Radiology, surgery, radiotherapy, and outcome ☆

Out of 936 primary intracranial meningiomas, 94.3% were histologically benign (grade I), 4.7% atypical (grade II), and 1.0% anaplastic (grade III); one recurrence was sarcomatous (grade IV). Meningiomas with histologic anaplasia (grades II-IV) occurred in 12% of the men, but only 4% of the women. Only 26% of atypical or anaplastic meningiomas appeared completely innocent on a computed tomography scan. Angiograms, usually showing a meningeal feeding artery, suggested meningioma when computed tomography scans did not. At 5 years after complete removal, the recurrence rate was only 3% (21% at 25 years) for benign meningiomas, but 38% for atypical ones, and 78% for anaplastic ones. The median times to recurrence were 7.5, 2.4, and 3.5 years, respectively. In spite of postoperative radiotherapy, four of five anaplastic meningiomas recurred.

Prediction of psychosocial recovery after head injury with cognitive tests and neurobehavioral ratings

A series of 53 patients was studied using a battery of tests and a neurobehavioral rating scale on average 4 months after closed-head injury (CHI). Social outcome was assessed 1 year after injury by interviewing a family member. The results supported the hypothesis that tests of flexibility and programming rather than tests of cognitive skills predict psychosocial recovery after CHI. Spatial Learning with Self-Set Goals and Sorting were measures of flexibility and programming. Contrary to expectation, word fluency performance was unrelated to these measures, but was associated with conventional intelligence tests, which did not predict psychosocial recovery. Cognition/Energy deficit on the Neurobehavioral Rating Scale and increased age were useful predictors of poor psychosocial outcome, whereas computed tomography findings or the Glasgow Coma Score were weakly related to the outcome indices. Evidently, cognitive flexibility and mental programming are very important psychological prerequisites of social recovery after CHI.

Dual task performance after focal cerebral lesions and closed head injuries.

The aim of this study was to demonstrate that focal frontal lobe lesions and closed head injuries cause a deficit in the deliberate minimizing of dual task decrements that follow when two separate tasks should be done concurrently. In single tasks, subjects counted backwards and cancelled visual targets as quickly and accurately as possible on separate 1 min trials. In the dual task, they were required to do both tasks simultaneously, taking care that performance on neither task would be notably more impaired than on the other, as only the performance showing a larger percentage decrement from the corresponding single task performance was taken into account as the result of the test. Patients with acute closed head injury displayed more pronounced dual task decrement than the controls. This deficit was not secondary to inefficiency on the single tasks but was related to the depth of coma at admission, the acuteness of injury and age. Contrary to expectation, patients with focal frontal lobe lesions or patients with subacute closed head injury did not demonstrate abnormal dual task decrement.

Social outcome related to cognitive performance and computed tomographic findings after surgery for a ruptured intracranial aneurysm

A series of 83 patients was examined with a battery of cognitive tests, a clinical interview, and computed tomography 1 year after surgery for a ruptured intracranial aneurysm. Disability on the Glasgow Outcome Scale (33%), failure to return to work (25%), impaired social relations (25%), and subjective or clinical mental impairment (56%) were found to be related to each other and to poor performance on cognitive tests, especially to verbal impairments in patients with left lateral infarctions and to memory deficits and cognitive inflexibility in patients with frontal medial infarctions. Furthermore, cognitive deficits and poor outcome were associated with diffuse brain damage. Depression and anxiety were unrelated to test performances, but were frequently reported by patients with right lateral infarctions.

Agenesis of the left internal carotid artery associated with an aneurysm on the right carotid syphon: Case report

A case is reported with congenital absence of the left internal carotid artery associated with an aneurysm on the contralateral carotid syphon. Eight similar cases are reviewed in brief. The possibility of hemodynamic abnormality as the cause of the aneurysm is discussed.

Cognitive deficits related to computed tomographic findings after surgery for a ruptured intracranial aneurysm

A consecutive series of 118 patients operated on for ruptured intracranial arterial aneurysms was studied. Ninety-six of them could be adequately examined with a battery of psychological tests and computed tomographic scans 1 year after a subarachnoid hemorrhage. Seventeen orthopedic control patients with no history of brain damage were also tested. The pattern of cognitive deficits was strongly related to the findings on the computed tomographic scans. Patients with left lateral infarctions had deficits on performances requiring verbal efficiency, including memory and classification tasks, whereas patients who had right lateral infarctions were poor on a visuoconstructional task (the copying of Reys Figure). These deficits were pronounced when lateral infarction was associated with diffuse brain damage. Patients with frontal medial infarctions had low scores on memory tests; the inefficiency in verbal fluency, categorical reasoning, and memory was related to diffuse brain damage. The patients who had no infarctions did not differ significantly from the control group. Cognitive impairments after left lateral and frontal medial infarctions, as well as diffuse brain damage, correlated with the Glasgow Outcome Scale.

Frontal Tests Do Not Detect Frontal Infarctions after Ruptured Intracranial Aneurysm

The series of 155 patients operated on for a ruptured intracranial arterial aneurysm was examined using typical frontal tests (the Stroop test, word fluency tasks, and a sorting task), as well as a learning and memory test. Patients with frontal infarction were not significantly inferior to patients with non-frontal infarction or to patients with no infarction. Frontal patients, however, were unable to return to work as often as non-frontal patients and more frequently than those with no infarction. These results indicate that the frontal tests used in this study are not selectively sensitive to mainly medial frontal infarctions that follow the rupture of an anterior cerebral artery aneurysm.

Word list learning and prediction of recall after frontal lobe lesions

The effect of frontal lobe lesions on the accuracy of prediction of recall in a word list learning task was studied. Fifty-nine patients with a focal brain lesion and 21 non-brain-damaged control patients memorized a word list by selective reminding and predicted before each recall trial the number of words they would be able to recall. The patients with left frontal lesions, who were inferior to the patients with right frontal lesions and the control patients in word list recall, overpredicted their recall more than the other brain-damaged patients or the control patients, especially on the 1st trial. The patients with right frontal lesions were less accurate in the prediction of recall than the patients with right posterior lesions or the control patients.

Computed tomography and angiography do not reliably discriminate malignant meningiomas from benign ones

SummaryHistological anaplasia, found in up to 10% of meningiomas, is an important prognostic sign as it is associated with increased recurrence rate and volume growth rate. We studied in retrospect a series of 230 primary intracranial meningiomas to discover whether histological anaplasia can be reliably foreseen in CT scans and angiograms. 205 meningiomas were histologically benign, and 25 meningiomas were classified as malignant (atypical or anaplastic), with either incipient (20) or overt (5) signs of anaplasia. Often CT parameters tested, three were associated significantly more often with malignant meningiomas: nodular contour (58.3% vs 26.7%), cysts (20.0% vs 4.4%) and absence of calcifications (92% vs 65.3%); none of these parameters was an absolute sign of anaplasia. ‘Mushrooming’, previously regarded as a definite sign of malignancy, was seen in 9% of benign meningiomas and in 21% of malignant ones. In angiography, no apparent differences between benign and malignant meningiomas were seen. The conclusion is that it is not possible to distinguish malignant meningiomas from benign ones with CT or angiography.

Inaccurate prediction of retrieval in a face matrix learning task after right frontal lobe lesions

This study partly supports the hypothesis that frontal lobe lesions cause impairment of metamemory. Fifty-nine patients with a focal brain lesion and 21 non-brain-damaged patients memorized a 4 X 4 matrix of 16 faces in 6 consecutive trials and predicted the number of locations of faces they would be able to remember before each retrieval. When age-related impairment of learning was adjusted, the patients with right posterior lesions were inferior to the controls and to the patients with right frontal lesions on the total number of correctly placed faces. The patients with right frontal lesions were less accurate than the patients with right posterior lesions or the controls in the prediction of retrieval. The inaccuracy of retrieval prediction in the face test was associated with that in a word-list learning task.