Incomplete Third Nerve Palsy Due to a Carotid-Cavernous Fistula.

Introduction: The approach to oculomotor nerve palsies involves the exclusion of compressive, infective, inflammatory, or ischemic lesions. Dural arteriovenous fistulae, including carotid-cavernous fistulae (CCF), are known causes of third nerve palsy. However, diagnosis can sometimes be delayed or missed due to the various clinical presentations.

Post-stroke patients with moderate function have the greatest risk of falls: a National Cohort Study.

Background: Stroke patients have increased risks of falls. We examined national registry data to evaluate the association between post-stroke functional level and the risk of low falls among post-stroke patients.

Methods: This retrospective cohort study analyzed data from national registries to examine the risk factors for post-stroke falls.

Revisiting the public awareness, attitudes, and understanding towards epilepsy among Singapore residents.

A survey to assess the familiarity, attitudes, and knowledge about epilepsy was done using a questionnaire identical to the one used in 1999. Two hundred forty-six people participated in our survey in 2017 as compared with 214 in the 1999 survey. In terms of familiarity about epilepsy, 76% had heard or read about epilepsy, 55.

Ictal and interictal EEG patterns in patients with nonconvulsive and subtle convulsive status epilepticus.

Background: Electroencephalography findings in nonconvulsive or subtle convulsive status epilepticus (NCSE and SCSE, respectively) can be heterogenous. We aimed to study the different patterns on EEG in our cohort of patients.

Objective: Our objective was to study ictal and interictal EEG patterns in patients with NCSE and SCSE.

Central pontine myelinolysis presenting as isolated sixth nerve palsy in third trimester of pregnancy.

A 30-year-old primigravida presented with isolated left sixth nerve palsy at 38 weeks gestation. Her MRI showed a lesion consistent with central pontine myelinolysis (CPM). Extensive investigations did not reveal any secondary cause for the CPM.

Surgical outcomes in patients with extratemporal epilepsy and subtle or normal magnetic resonance imaging findings.

Background: Surgery is an important therapeutic option in patients with medically refractory epilepsy. The combination of an extratemporal epileptic focus and nonlesional magnetic resonance imaging (MRI) was often believed to portend a poor outcome.

Objective: To investigate the outcome and analyze potential prognostic predictors in patients without lesions on MRI who underwent extratemporal resections.

Combined temozolomide and radiation as an initial treatment for anaplastic glioma.

Aim: Combined temozolomide (TMZ) and radiation therapy (RT) is often used as initial treatment for anaplastic glioma. However, there is no prospective randomized data available that proves the efficacy of the combination for anaplastic glioma. In this retrospective study we aimed to compare the outcome of patients who had combined TMZ and RT with those who had RT alone for the initial treatment of anaplastic glioma in our centers.

Promising role of [18F] fluorocholine PET/CT vs [18F] fluorodeoxyglucose PET/CT in primary brain tumors-early experience.

Primary brain tumors (PBT), in particular gliomas, are among the most difficult neoplasms to treat, necessitating good quality imaging to guide clinicians at many junctures. Current imaging modalities, including [18F] fluorodeoxyglucose (FDG) PET/CT, MRI and MR spectroscopy (MRS), have various limitations, particularly with regard to differentiating tumor from radiation induced necrosis (RIN) and from normal cerebral metabolic uptake. [18F] fluorocholine (FCH) is an analog of choline with potentially optimal imaging characteristics, as pharmacokinetic studies with FCH conducted in patients showed minimal FCH uptake by normal brain parenchyma, whereas high-grade tumors are known to have increased choline uptake.

Vanishing glioblastoma after corticosteroid therapy.

A recurrent right temporal glioblastoma that vanished on MRI after a short course of intense corticosteroid therapy is reported. This was associated with development of new multicentric lesions in the right frontal lobe and right splenium of the corpus callosum. Rapid disappearance of tumor with steroid therapy is frequently associated with lymphoma and is rarely described in high-grade gliomas.

Characterization of a side population of astrocytoma cells in response to temozolomide.

Object: Cancer progenitor-like cells isolated by Hoechst 33342 dye efflux (termed the "side population" [SP]) have been studied in a variety of cancers, including malignant brain tumors. In this study, the authors investigate the nature of the SP phenotype in 2 glioma cell lines, U87MG and T98G, and their response to temozolomide. The roles of several adenosine triphosphate-binding cassette (ABC) multidrug transporters expressed by SP cells, in particular ABCG2, are also examined.

Cryopreservation of neurospheres derived from human glioblastoma multiforme.

Cancer stem cells have been shown to initiate and sustain tumor growth. In many instances, clinical material is limited, compounded by a lack of methods to preserve such cells at convenient time points. Although brain tumor-initiating cells grown in a spheroid manner have been shown to maintain their integrity through serial transplantation in immune-compromised animals, practically, it is not always possible to have access to animals of suitable ages to continuously maintain these cells.

A rare cause of reversible unilateral third nerve palsy.

Case Report: A 59-year-old Chinese male presented in January 2007 with acute left retro-orbital headache, diplopia and left partial ptosis. Isolated left third nerve palsy was diagnosed. Imaging studies and cerebral angiography excluded a posterior communicating artery aneurysm.

Application of the McDonald MRI criteria in multiple sclerosis.

Introduction: The aim of this study was to assess the sensitivity of McDonald's magnetic resonance imaging (MRI) criteria for the diagnosis of multiple sclerosis (MS) in a group of Asian patients diagnosed with clinically definite MS, based on lesion characterisation on MRI scans.

Materials And Methods: Forty-nine patients from 3 major neurological institutions were classified as having Asian- or Western-type MS based on clinical assessment. Each MRI scan was reviewed by 2 neuroradiologists for the presence and characteristics of brain and spinal lesions.

Chemotherapy in adults with gliomas.

Treating patients with gliomas requires a multidisciplinary approach, which often includes surgery, radiation and chemotherapy. Recent developments have demonstrated the efficacy of chemotherapeutic agents in patients with newly diagnosed or recurrent gliomas. Large clinical studies have provided important information on the impact of chemotherapy for anaplastic oligodendrogliomas in the upfront setting.

Improvements in quality of care resulting from a formal multidisciplinary tumour clinic in the management of high-grade glioma.

Introduction: There is increasing belief that a formal protocol-based multidisciplinary care model should be adopted as an optimal care model in oncology. However, there is minimal outcome evidence to demonstrate an improvement in patient care. The aim of this study was to compare clinical quality outcomes between patients with high-grade glioma managed at one hospital using a formal neuro-oncology multidisciplinary tumour clinic (MTC) and a second hospital with a traditional on-call referral pattern (non-MTC).

Salvage chemotherapy in progressive high-grade astrocytoma.

Introduction: Despite aggressive multidisciplinary interventions, patients with high-grade astrocytomas experience tumour progression or recurrence. Treatment for this group of patients remains a formidable challenge. We describe our experience of salvage chemotherapy for these patients.

Improved median survival for glioblastoma multiforme following introduction of adjuvant temozolomide chemotherapy.

Introduction: The use of adjuvant temozolomide (TMZ) in patients managed with surgery and adjuvant radiation therapy (RT) for glioblastoma multiforme (GBM) has been demonstrated to improve median and 2-year survival in a recent large international multicentre study. To confirm this result in routine clinical practice, an audit of the management and outcome of patients with GBM at The Cancer Institute Radiation Oncology was performed.

Materials And Methods: All patients with GBM managed radically at The Cancer Institute Radiation Oncology from May 2002 to 2006 were entered into a prospective database.

Primary central nervous system lymphoma in an Asian population: a 15-year experience.

Background: The aim of this study was to characterize primary central nervous system lymphoma (PCNSL) among Asian patients and to determine their outcomes with different therapeutic modalities.

Patients And Methods: Between 1990 and 2005, 37 patients with PCNSL were analyzed within 5 different treatment groups: radiotherapy alone (arm A), combined chemoradiation (arm B), chemotherapy alone with methotrexate (MTX) > or = 1 g/m2 (arm C), miscellaneous therapy (arm D), and best supportive care (arm E).

Results: The median age at presentation was 59 years, and the majority of patients were male (68%).

The prognostic impact of histology and 1p/19q status in anaplastic oligodendroglial tumors.

Background: It has been reported previously that the combined loss of chromosomal arms 1p and 19q is a significant predictor of outcome for patients with anaplastic oligodendroglial (AO) tumors and that such chromosomal loss correlates with classic histology in AO. The authors sought to determine whether histology was an equivalent or superior predictor of outcome compared with 1p/19q status in 131 patients with AO tumors.

Methods: The status of 1p and 19q was determined using real-time, quantitative polymerase chain reaction analysis and/or fluorescence in situ hybridization.

Comparison of magnetic resonance spectroscopy and perfusion-weighted imaging in presurgical grading of oligodendroglial tumors.

Objective: Oligodendroglial tumors form an uncommon, but distinct, subgroup of gliomas with longer survival, better treatment response, and characteristic genetic alterations. Noninvasive grading of oligodendroglial tumors using functional and metabolic magnetic resonance imaging may be helpful in guiding the treatment approach and predicting malignant transformation of these tumors. We used perfusion-weighted magnetic resonance imaging and proton magnetic resonance spectroscopic imaging (MRSI) to predict the oligodendroglioma grade.

Anaplastic astrocytoma: diagnosis, prognosis, and management.

The designation of a tumor as anaplastic astrocytoma (AA) reflects a distinct histologic classification of malignant glioma characterized by an abundance of pleomorphic astrocytes with evidence of mitosis. Although these tumors are malignant, they have a better prognosis and a higher likelihood of response to treatment than glioblastoma. Despite advances in brain tumor imaging, making an accurate diagnosis requires the evaluation of tumor tissue and is essential for treatment planning.

13-cis-retinoic acid in the treatment of recurrent glioblastoma multiforme.

Basic science and clinical investigations have demonstrated that 13-cis-retinoic acid (cRA) has activity against malignant gliomas. To assess its effectiveness in the setting of recurrent glioblastoma multiforme (GBM), we performed a retrospective analysis of the medical records and neuroimaging results of patients with recurrent GBM who were treated with cRA. The toxicity profile of cRA, response, and effect on progression-free survival from initiation of treatment were end points of our analysis.