CASE HISTORY

Patient unable to give reliable information. Wife stated he had been unsteady on his feet and had had headaches for some weeks, with loss of memory for one week. For a few months he had not been as willing as usual to go to work and did not seem to have the same spirit. Gave up his work a month before admission. No vomiting and never unconscious. Very rude and difficult to manage. Destructive in last week, smashing his glasses etc. Incontinence of urine for 4-5 days. On examination, smells better with left than right nostril. Visual fields appear full. Right disc margin blurred. Cup filled; red nerve head with central haemorrhage. Left disc relatively normal. Pupils normal and normal reactions. All cranial nerves normal, apart from first, and a slight tremor of tongue on both sides with slight weakness of left face at rest. Arm and leg reflexes nil abnormal, but inco-coordination in heel and knee test. Romberg positive; gait ataxic. C.S.F. pressure 250mms. Globulin negative. protein 80 mgms, chlorides 700mgms. The patient died the day following right temporal decompression. Clinical diagnosis - glioma of right frontal lobe, with spread to corpus callosum suggested by mentality.

PATHOLOGY

At autopsy the dura was under some tension and the brain projected through the decompression opening. Tumour was adherent to the dura in the posterior part of the anterior fossa, near and at the middle line, and more extensively to the right than the left. Right olfactory nerve compressed, and further investigation showed a growth the size of the walnut involving both hemispheres but mainly the right. It passed upwards from the base of the posterior end of the right frontal lobe into the rostral region of the corpus callosum, and this tissue extended a little into the left hemisphere. The specimen shows an anteroposterior slice of the left cerebral hemisphere showing apparently capsulated growth projecting into the frontal lobe on that side, the growth being translucent at the periphery, caseous in the centre.