Zur Problematik der Früherkennung von Hirngeschwülsten, die als einziges Symptom epileptische Anfälle hervorrufen

Summary

The diagnosis of brain tumour could not be made in 91 cases at the first investigation in a group of 1155 brain tumours. Slowly growing gliomas causing only epileptic fits and no other symptoms are especially difficult to diagnose.

Of 21 personal observations of tumour seizures, in which the diagnosis of the neoplasm was missed at the first investigation in hospital, 9 were oligodendrogliomas, 5 astrocytomas, 3 glioblastomas, 2 spongioblastomas, 1 gangliocytoma and 1 a metastasis. They were all located in the frontal or centroparietal region. In most cases the seizures appeared during the third or fourth decade. The average interval between the first epileptic fit and the tumour diagnosis was 8.2 years in cases of oligodendrogliomas and 2.2 years in astrocytomas.

5 patients had major seizures, 2 had psychomotor attacks and all the others suffered from partial epilepsy. Anticonvulsive therapy was often successfull; either the frequency of the fits diminished or, in 2 cases, the character of the seizures changed.

18 patients had a normal neurostatus at time of the first investigation. Only 3 patients had a slight difference of physiological reflexes, but no other pathological signs. In none of the patients did investigation of the CSF, skull X-rays, brain scanning, pneumencephalography or cerebral angiography first lead to the diagnosis of a brain tumour. The EEG alone showed focal signs corresponding to the location of the tumour in about 50% of the cases.

Zusammenfassung

Von 1155 Hirngeschwülsten war in 91 Fällen die Diagnose bei der ersten stationären Durchuntersuchung in einer neurologischen Klinik nicht gestellt worden. Insbesondere langsam wachsende Gliome, die zunächst lediglich epileptische Anfälle hervorrufen, entziehen sich leicht dem Nachweis.

An Hand von 21 eigene Beobachtungen, bei denen sich die zugrundeliegende Geschwulst zunächst nicht hat fassen lassen, werden die bei der Früherkennung der Tumorepilepsie anstehenden Probleme besprochen.