Claudia Baumann1,2, Julia Tichy3,4,5,6, Jan Hendrik Schaefer7, Joachim P Steinbach3,4,5,6, Michel Mittelbronn8,9,10,11,12, Marlies Wagner13, Christian Foerch7. 1. Department of Neurology, Goethe University, Schleusenweg 2-16, 60528, Frankfurt am Main, Germany. cb.claudiabaumann@hotmail.de. 2. Institute of Neuroradiology, Goethe University, Frankfurt am Main, Germany. cb.claudiabaumann@hotmail.de. 3. Dr. Senckenberg Institute of Neurooncology, Goethe University, Frankfurt am Main, Germany. 4. German Cancer Consortium (DKTK), Partner Site Frankfurt/Mainz, Frankfurt, Germany. 5. German Cancer Research Center (DKFZ), Heidelberg, Germany. 6. University Cancer Center (UCT), Frankfurt, Germany. 7. Department of Neurology, Goethe University, Schleusenweg 2-16, 60528, Frankfurt am Main, Germany. 8. Institute of Neurology (Edinger Institute), Goethe University, Frankfurt am Main, Germany. 9. Luxembourg Centre of Neuropathology (LCNP), Luxembourg, Luxembourg. 10. Laboratoire National de Santé (LNS), Dudelange, Luxembourg. 11. Luxembourg Centre for Systems Biomedicine (LCSB), University of Luxembourg, Esch-sur-Alzette, Luxembourg. 12. NORLUX Neuro-Oncology Laboratory, Department of Oncology, Luxembourg Institute of Health (L.I.H.), Luxembourg, Luxembourg. 13. Institute of Neuroradiology, Goethe University, Frankfurt am Main, Germany.
Abstract
PURPOSE: Cognitive functions are differentially represented in brain hemispheres. Aphasia is an "easy to recognize" symptom of diseases affecting the left side. In contrast, lesions in the right hemisphere cause subtle neuropsychological deficits such as neglect and anosognosia. We evaluated whether right-sided malignant brain tumors are on average larger at the time of first diagnosis as compared to left-sided tumors, and extrapolated the delay in diagnosing right-sided tumors compared to the left side. METHODS: All first-ever diagnosed glioblastoma (GBM) patients between 2005 and 2012 were identified using our hospital-based prospective research registry. Baseline data, information on initial clinical presentation and imaging findings (including tumor volume) were collected. Extrapolation of time since tumor initiation was based on an established gompertzian growth model. RESULTS: We included 173 patients. Mean age of the study population was 58 ± 13 years. Tumors located in the right hemisphere (n = 96) were larger as compared to tumors located in the left hemisphere (n = 77) (median 36.4 mL [interquartile range 13.0-56.0; minimum 0.2, maximum 140.0] vs. 17.2 mL [7.7-45.1 mL; 0.4, 105.2]; p = 0.011). Right-sided tumors grew longer than left-sided tumors (378 ± 95 days vs. 341 ± 74 days; p = 0.006). Initial neuropsychological symptoms differed depending on the affected hemisphere. CONCLUSION: Right-hemispheric symptoms appear to be less clinically conspicuous resulting in a delayed diagnosis of GBM, which might be improved by raising awareness for the corresponding neuropsychological deficits. Whether our findings have prognostic implications needs to be evaluated in future studies.
PURPOSE: Cognitive functions are differentially represented in brain hemispheres. Aphasia is an "easy to recognize" symptom of diseases affecting the left side. In contrast, lesions in the right hemisphere cause subtle neuropsychological deficits such as neglect and anosognosia. We evaluated whether right-sided malignant brain tumors are on average larger at the time of first diagnosis as compared to left-sided tumors, and extrapolated the delay in diagnosing right-sided tumors compared to the left side. METHODS: All first-ever diagnosed glioblastoma (GBM) patients between 2005 and 2012 were identified using our hospital-based prospective research registry. Baseline data, information on initial clinical presentation and imaging findings (including tumor volume) were collected. Extrapolation of time since tumor initiation was based on an established gompertzian growth model. RESULTS: We included 173 patients. Mean age of the study population was 58 ± 13 years. Tumors located in the right hemisphere (n = 96) were larger as compared to tumors located in the left hemisphere (n = 77) (median 36.4 mL [interquartile range 13.0-56.0; minimum 0.2, maximum 140.0] vs. 17.2 mL [7.7-45.1 mL; 0.4, 105.2]; p = 0.011). Right-sided tumors grew longer than left-sided tumors (378 ± 95 days vs. 341 ± 74 days; p = 0.006). Initial neuropsychological symptoms differed depending on the affected hemisphere. CONCLUSION: Right-hemispheric symptoms appear to be less clinically conspicuous resulting in a delayed diagnosis of GBM, which might be improved by raising awareness for the corresponding neuropsychological deficits. Whether our findings have prognostic implications needs to be evaluated in future studies.
Entities:
Keywords:
Brain tumor; Growth; Neuropsychology; Side
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