CASE REPORT

Diagnosis: Brain tumor (pilocytic astrocytoma) - EO

A girl who was born in 1982 started to experience weakness, loss of appetite in 1990. When her symptoms worsened, and she lost remarkable weight, she was taken in February 1991 to Mediterranean University in Antalya (Turkey). Computer aided tomography (CAT) of  the brain performed on 6 February 1991 demonstrated a tumor in cerebellum ( Appendix EO1 ).

She was admitted on 8 February 1991 to the Neurosurgery Department of Istanbul University Medical Faculty at Capa. Magnetic resonance (MR) images obtained on the same day showed a 52x54mm central mass in suprasellar cistern with marked hydrocephalus ( Appendix EO2 ). Biopsy was performed on 12 February 1991 by right frontal craniotomy. Histopathological examination of the resected specimen revealed the diagnosis as pilocytic astrocytoma ( Appendix EO3 ). Hornaa catheters were placed at both frontal sites. In the post operative period, 3^rd nerve paresis occurred in the right eye. Her symptoms improved slightly. CAT scan demonstrated a decrease in hydrocephalus. She was discharged on 27 February 1991 with recommendation of radiotherapy ( Appendix EO4 ).

The patient received some radiotherapy in March for four days, however, the radiotherapy was abandoned when the general condition of the patient deteriorated.

On 29 August 1991 the patient was taken to Dr. Ozel. She was unable to move her arms and legs, and was being carried in arms. She was indifferent to the surrounding, she did not answer any question. She always stared at a fixed location. She was started N.O. treatment with 0.4mL of NOI. She was recommended to receive 0.4mL of NOI daily, six days per week. Because of poor prognosis, she was given medication for one month only.

In one month time, the father reported that the patient’s general condition improved, that she was interested in her surrounding, that she could eat on her own. The patient was recommended to continue NO treatment and was supplied with medication sufficient for another two months.

The patient presented to Dr. Ozel on 15 December 1991 together with her mother and father. They had with them a CAT scan performed on 12 December 1991. Tumor had decreased in size to 41.8x40.8mm, and hydrocephalus lessened ( Appendix EO5 ). None of her previous symptoms were present, her general condition was normal. She said that she wanted to go to school, she was told that she could do so. She was recommended to continue NO treatment, she was supplied with medication sufficient for three months.

In March 1992, her parents acknowledged that she was doing good, they got more medication for her to continue NO treatment.

CAT scan performed on 26 June 1992 demonstrated that the tumor decreased further in size to 27.3x27.6mm ( Appendix EO6 ). Hydrocephalus had lessened too. The patient was scared of injections, she was recommended to receive NOI injections on alternate days.

CAT images obtained on 30 November 1992 revealed the size of the tumor as 21.6x12mm ( Appendix EO7 ). The patient had no symptom related to her previous disease. She was started on a maintenance regimen with 0.4mL of NOI to be given twice a week. She received this maintenance regimen for six months, and her N.O. treatment ended.

CAT scan performed on 23 September 1993 showed the size of the tumor as 21.6x23mm ( Appendix EO8 ). However, no treatment was recommended since the general condition of the patient was very good.

Another CAT scan was performed on 3 January 1994. In the evaluation report, tumor size was stated to be 35x35mm ( Appendix EO9 ). The patient was free of any symptom. She was then referred to Ass. Prof. Dr. Nezih Ozkan for consultation. Dr. Ozkan reported that the tumor did not increase in size, that the previous (35x35mm) evaluation was not correct. He recommended her to undergo another check up in three months time ( Appendix EO10 ).

 MR images obtained on 16 May 1994 demonstrated no lesion. The evaluation report stated some post operative changes, and slight hydrocephalus ( Appendix EO11 ).

A follow up CAT scan performed on 28 April 1998 revealed no pathological finding ( Appendix EO12 ).

As in 2008, she is in good health, and lives normal day life.