CASE REPORT

Diagnosis: Brain Tumor (ependymoma) - SD

A 19-year-old woman was diagnosed in 1979 as having ependymoma at the Neurosurgery Clinic of Istanbul University Medical Faculty (NCIUMF); the brain tumor was surgically removed. Relapse occurred in 1981, and the patient presented to the same clinic for another surgical removal of the tumor.

In November 1984, the patient experienced headache, forgetfulness, and vomiting. Tomography demonstrated relapse tumor, and the patient was again hospitalized at NCIUMF on 29 November 1984. Relapse tumor was removed once more, histopathological examination of the tumor corroborated the previous ependymoma diagnosis. The patient was discharged from the clinic on 10 December 1984 ( Appendix SD0 ).

In June 1985, the patient experienced a general feebleness as well as poor memory, and she presented again to the NCIUMF. A brain CAT scan was performed on 10 July 1985 ( Appendix SD1 ); it showed relapse of the tumor again, and the patient was recommended radiotherapy. However, not only radiotherapy provided no benefit and her symptoms persisted, but also right hemiparesis (4/5), which included the face, occurred. Another brain CAT scan, performed on 2 September 1985, demonstrated enlargement of the relapse ependymoma tumor in the left rear ventricle, infiltration to the right site, and hydrocephalus ( Appendix SD2 ). The tumor was considered to be inoperable. A ventriculo-peritoneal shunt was placed to provide relief from hydrocephalus; this provided some improvement in the right hemiparesis. The patient was discharged from NCIUMF on 18 September 1985 ( Appendix SD3 ).

The patient was taken to Dr. Ozel on 10 October 1985. She was in a very poor medical condition. She was being carried on a stretcher. She was unable to stand up due to the weakness of her arms and legs. Although she was awake, she had no awareness of her surrounding, and she was unable to answer any question. She appeared to be uncomfortable and agitated. Her blood pressure was 80/55 mm Hg, her pulse was weak and 140/min. Her body temperature was 36.1^o C. 0.3 cc test dose of NOI caused her body temperature to rise to 38.4^o C. She was placed on a regular daily regimen of 0.3 cc dose of NOI to be given six times per week. It was advised to adjust the dosage according to the maximum fever occurring after NOI injections.

A home visit to the patient's house on 5 January 1986 revealed: The feebleness in her legs and arms as well as her uncomfortable and agitated appearance had completely disappeared. She was aware of the events around her. She could walk with the help of others; she was able to take care of her body's natural needs. She was recommended to continue N.O. treatment as previously described.

On 10 April 1986, she visited Dr. Ozel at his office. She could walk on her own. Her talk and communication were normal. She could not remember the office and her previous visit there in October 1985. She had a brain CAT scan performed on 5 April 1986 that showed remarkable regression of the tumor ( Appendix SD4 ). However, 0.3cc dose of NOI was still causing a fever of about 37.5^o C, and the patient was recommended to continue the regular regimen as previously described.

When the patient experienced no rise in body temperature after NOI injections, she was started on 2 May 1986 on a maintenance regimen with 0.3 cc dose of NOI to be given on alternate days. In three months time, the patient was recommended to change the regimen to 0.3cc dose of NOI to be given once every three days, and to stop NO treatment in three months time.

The brain CAT scan performed on 13 December 1986 demonstrated "no relapse tumoral lesion" ( Appendix SD5 ).

Another brain CAT scan, of which a copy is unavailable, was performed on 22 May 1987. It revealed "no medical change with respect to the previous CAT scan performed on 13 December 1986.

Further follow up MR images were obtained on 24 April 1998; they demonstrated cerebellar and cerebral atrophy, and no sign of any relapse ependymoma tumor ( Appendix SD6 ).

As in 2006, the patient has been in remission and living her normal daily life.