Central Nervous System Lesions Update 7/31/02

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Dr. Grois's Article on CNS Involvement
MR Images

CNS lesions are rare for both LCH & JXG.  Ben has at least 3 main lesions with a total of 8.  They are deep in the brain - which is not overly common.  We believe they are what is called 'space occupying lesions'.  Early on, our best estimate of lesion growth was 10% in 10 days (estimated from MRI comparisons from 4/10 to 4/20).  The lesions seemed to slow to under 5% growth per month, but more recently they were back up to approximately 10 to 15% per month (6/19 to 7/19) with the addition of four new lesions.  Not good news.

Discussion from July of 2002

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Name & color scheme:
• Tumor A is Yellow
• Tumor B1 is Mint Green
• Tumor B2 is Bright Green
• Tumor B3 is Red
• Tumor C is Pink
• Tumor D is Orange
• Tumor E is Blue
• Tumor F is Purple


Here are the possible symptoms associated with each lesion:

• A) Yellow - Hydrocephalus
• B1 & B2) Green - Loss of left field of vision
• B3) Red - Sunset vision (eyes look down only), ataxia (loss of coordination and motor skills)
• C) Pink - Seizure
• D) Orange - Cortical lesion near motor strip - loss of motor skill on right side
• E & F) Blue & Purple - Developmental lag, trunk ataxia, nystagmus, impaired fine motor reflex, poorly articulated speech


Artifically colored scans from 7/19/02 - MRI is Black & White, PET is in Color on Right










New Lesions??  See the bright spot?

 
 

Discussion from May of 2002 (see images above for newer discussion)

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We have labeled the tumors A, B, C, D & E for discussion.

Here is what we believe the impact of the tumors are / could be:
Tumor A (Largest in the ventricle) - YELLOW
. Possible anterior fontanel swelling
. Pressure - Irritable, Poor Feeding - Headache symptoms
. Possible surgery to remove blockage if chemo is not implemented quickly and we do not get a response
Tumor B (Near hypothalamus – in the internal capsule) - GREEN
. Possible decreased strength and motion on the left side of the body
. Could see decreased visual ability out of left side of body, left visual field
Tumor C (In right temporal lobe) - RED
. Could cause seizures?
Tumor D – no symptoms
Tumor E - BLUE - Cerebellum - not sure if it is there yet, will monitor

Sketches
This sketch show the locations of the main tumors.


This sketch shows the main tumors from the side.  I have also added in the biopsy path.  You can see the ventricles outlined.  Tumor A is close to blocking the path from the central ventricle to the lateral ventricles.

 

MR Scans

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For all images below, the image on the left is the MRI as it appears & the image on the right has each of the main tumors highlighted (artificially by me).

7/19/02 MR Images
Coming Soon (see above in the interim)

6/19/02 MR Images
Coming Soon

5/22/02 MR Images
Animation - Back to Front
Animation - Right to Left
Animation - Bottom to Top

5/9/02 MR Images
Animation - Back to Front

4/20/02 MR Images
No images yet....

4/10/02 MR Images
Animation - Back to Front
Animation - Bottom to Top
Stills

Comparisons
MRI Size Change Comparison 4/20/02 to 5/9/02
 

 

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