Encephalomalacia in Grd 3 astrocytoma

[Judy O'Shaughnessy]

My husband has a Grd 3 astrocytoma.  Since 4/98 he's had 2 open cranis with Gliadel wafers, 30 ext. beam radioadtion tx's, 6 sessions of P,V, Etoposide.  One session of BBBD which we stopped cause he could not tolerate it.  Also has had extrensive rad. necrosis, and freq. need for Decfadron.  He has a large area of enhancement (3.5 cm) in the  Lt. parieto-occip lobe, stable since 9/99 and showing up as rad, nec. after 3 MR Spect scans-most recent one 9/99.

In spite of his stable MR he continues to deteriorate.  Currently he's very lethargic, has signif Rt. leg weakness and now some atrophy, intermitt. expressive aphasia.  He has not responded to the Decadron as well as in the past.  His neurosurgeon suggests he may have encephalomalacia as a resuolt of all his treatment.  I know this is shrinkage of brain tissue.  

If this is encephalomalacia, will this continue to get worse, if so how much worse (what is the end point), will he stay the same and continue to live in this state till the tumor progresses, or is there hope for improvement.  I am having difficulty finding any info on this condition.  What is the possibility some of the lethargy could be due to  hypothyroid from fallout radiation damaging his pituitary gland (we know there is some damage since he's producing almost no testosterone).

Thank you for taking the time to read my questions.
Judy O'Shaughnessy RN

[martiancn]

A related discussion, rehabilitation of infant encephalomalacia was started.

[doraw]

A related discussion, encephalomalacia was started.

[paul84]

A related discussion, headaches was started.

[Sara]

Will you translate the following finding into lay terms?  What is the medic looking for?  What does he suspect?  Is he talking about something threatening to the patient's safety?

"Head injury 1993.  CT at that time revealed left parietal encephalomalacia consistent with hx of old left infarid.  Please evaluate. . ."

Thanks.

Please reply to ***@****

[JENNY]

Thankyou for your response.  The day after I wrote that question, we were again in the ER, and this time they did a lumbar puncture.  The CSF was clear and so the treating doctor told us that he had ruled out anything dangerous and that this was a migraine condition.  The headaches when they occur are on both sides of the head from the eyebrow area back to the nape of her neck.  She has been prescribed propranolol for these headaches, however since the last visit to the ER(4 days ago) she has experienced a constant headache of mild intensity which very quickly progresses to moderate and severe if multiple medications are not taken to prevent it.  The current medications used to control the pain are vicodin, darvocet, excedrin (migraine), ibuprofen, propranolol, acetaminophen and naprosen.  If this is the onset of a migraine condition can we expect the intensity and frequency of these headaches to subside with time?  We are keeping a headache diary to try and pin point possible precipitating factors but so far there is nothing that stands out as being the cause.  Any help you could give would be appreciated.
Many thanks

[CCF Neuro[P] MD, RPS]

Dear Jenny:

Your partner is on too many medications.  I would stop all the medications except for the beta blocker.  When you stop the medications you might have a rebound headache but unless you stop the medications, you will resolve your partner into a chronic daily headache person.  When you stop, if you have breakthroughs, I would give 800 mg of advil and then 600 mg of tylenol at once.  You can give this every 8 hours for the headache.  The medications your stopping do not affect the pathophysiology of the migraine, only the pain.  The beta blocker will act on what is causing the headache.  Also, if the headache is bilateral, then your partner doesn not have hemicranial (one-sided) cephalgia (headache).

Sorry, I wasn't much help.

Sincerely,

CCF Neuro MD

[CCF Neuro[P] MD, RPS]

Dear Jenny:

Sorry to hear about your partner's headaches.  The cerebral edema is worrisome.  I hope that the MRI did not show edema, but only the results of cerebral edema.  Trauma can cause headaches but not usually so far out from the headaches.  Has your partner had these headaches since the motorcycle accident?  I would highly suggest that your partner see a headache specialist.  It may be that your partner has hemicrania cephalgia (a type of headache that is one-sided and intense).

Sincerely,

CCF Neuro MD

[JENNY]

Recently I had to take my partner to the hospital following sudden onset of a severe headache where she felt her brain was going to 'pop'.  The headache subsided to a dull ache following two separate shots of demerol and a CT scan and MRI where performed indicating that there was cerebral edema and evidence of a previous head injury from a motorcycle accident 18 years ago.  There was a small area of cerebral atrophy in the frontal lobe.  She was discharged for follow up and prescribed vicodin.  4 days later I again had to take her to the ER as another crushing headache came upon her suddenly accompanied with vomiting.  The treating doctor said that the MRI scan had shown some encephalomalacia and this was causing migraines.  He gave us no indication of what might be bringing on these severe headaches.  Again this headache require demerol to subside, however this time it subsided only to leave her with a very bad headache which she is unable to relieve since being discharged from the hospital despite taking vicodin and ibuprofen.
My question is what can we do to help prevent the onset of these headaches?  What factors are likely to exacerbate this condition?  Are these headaches migraines related to this condition - I have never heard of migraines coming on so suddenly.  I understand that encephalomalacia is softening of the brain tissue but would like to know how this contributes to these symptoms.  Is this condition now one that will be chronic in nature or is this an acute episode that will subside with rest?  I would appreciate any information you can give me in regard to this condition.
Many thanks

[CCF Neuro[P] MD, RPS]

Dear Judy O'Shaughnessy:

I am very sorry to hear about your husband and all that he has gone through.  I would agree that your husbands encephalomalacia is due to all the treatements he has undergone.  When brain tissue dies, it is scavenged up by microglia and astrocytes and what is left is what is called encephalomalacia.  There is also likely irradiation damage as we can see this anywhere from 3 months to 3 years (a medical school memorizing scheme).  Unfortunately, unless this is edema (which can induce similar symptoms) it is likely not going to get much better.  There are things that you can give for his attention and awakeness.  One medication is ritalin, another is provigel.

I hope your husband reponds to decadron and this is just due to swelling.

Sincerely,

CCF Neuro MD