What exactly happened?
It's not uncommon to encounter athletic patients in our clinic presenting with neurological symptoms. Head injuries can cause a variety of issues both short and long term. However, this case stands out due to the gradual and unique change in speech behavior, writing skills, and memory loss within a short period of time. Specifically, the tumor detected in this patient was found to be Glioblastoma multiforme (GBM). GBM is the most common and most aggressive cancer in the brain. They are generally located in the cerebral hemispheres, but can be found anywhere in the brain or spinal cord. GBM is usually contain a mix of cell types, which explains why the tumor is difficult to treat due to its variety of different cells, some of which may be resistance to chemotherapy. Despite the severity of this disease, the symptoms are initially nonspecific that include headaches, personality changes, and nausea. Once the symptoms begin to worsen, it progresses rapidly and may lead to unconsciousness and, if left untreated, death.
But how does that explain the speech and comprehension abnormality?
In medicine, we call this aphasia, which is an acquired language disorder from brain damage affecting writing, reading, speaking, and listening. Specifically, we would call this Broca's Aphasia. Broca's area is defined as an area along the inferior frontal gyrus that is unique for language processing, which it is also the site that the tumor affected. Patients affected in Broca's area typically know "what they want to say, they just cannot get it out". They are typically able to understand words and sentences but have trouble generating fluent speech. Other symptoms that may be present include problems with fluency, articulation, word-finding, both orally and in writing.
What happens next?
Glioblastoma is highly aggressive and difficult to treat. Surgical resection is the first stage to treating this cancer. After surgery, radiotherapy is the mainstay of treatment along with chemotherapy. Despite the agressiveness of the tumor, the most important factors affecting the outcome are age, performance status, and tumor grade. Without any treatment, prognosis can be as little as 3 months. With treatment, survival of 1 to 2 years is typical. Ultimately, the earlier you get to a physician, the better the chance of survival!
Albert Hsia, MS-IV
Dr. David Carfagno, DO, CAQSM
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