Brain Tumor Res Treat.  2024 Apr;12(2):121-124. 10.14791/btrt.2024.0004.

Understanding the Brain-Heart Connection Through a Case of Angry Glioma Syndrome

• Sarmiento JVM
• Casis RM
• Opinaldo PVA

• KMID: 2555871
• DOI: http://doi.org/10.14791/btrt.2024.0004

Abstract

We discuss a patient with a tumor on the anterior corpus callosum who underwent open biopsy eventually succumbing to cerebrogenic fatal arrhythmia following wounded glioma syndrome. A healthy 37-year-old female patient was admitted to our department due to a history of headache for 13 months. MRI revealed a suspicious glioma infiltrating the anterior corpus callosum. Neurologic examination only showed low cognitive assessment score (Montreal Cognitive Assessment score 20/30). ECG was normal sinus rhythm. Steroids and levetiracetam were administered prior to operation. Patient underwent right frontal craniotomy and biopsy of tumor with unremarkable events. During the first hospital day, patient had episodes of bradycardia followed by decrease in sensorium. Brain CT scan showed progression of edema without hemorrhage within the tumor bed. This was followed minutes later by two episodes of generalized tonic-clonic seizures and pulseless ventricular tachycardia. Cardiac resuscitation was done for 24 minutes but patient eventually expired. Location of the lesion and the epileptogenicity of the peritumoral cortex greatly contributed to the patient’s demise. Involvement of the frontomesial structures, particularly the insula and the cingulate cortex, and their connection to the central autonomic network, increased susceptibility to arrhythmias. Decreased seizure threshold worsened post-operative edema, further aggravating the dysregulation of the brain-heart-connection.

Keyword

Glioblastoma; Brain neoplasm; Biopsy

Figure

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  Fig. 1 Preoperative MRI. A and B: T1-weighted (A) and T2-weighted (B) images showed a mixed intensity predominantly hyperintense representing areas of microcystic changes involving the bilateral frontal lobes, anterior cingulate gyri, rostrum, genu and anterior body of the bilateral corpus callosum. C: Fluid attenuated inversion recovery image showing the extent of the lesion. D: Noted faint enhancement on gadolinium contrast. E and F: Diffusion-weighted imaging (E) and apparent diffusion coefficient (F) showing restricted diffusion in some areas within the lesion. G: Gradient echo susceptibility shown representing areas of necrosis. H: Sagittal view of the lesion.

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  Fig. 2 Histopathology of the tumors. A: On frozen section, a crush preparation was done showing cells with epithelioid and spindle cell features. Nuclei appear low grade and do not exhibit pleomorphism (H&E, ×100). B: High power view shows a very cellular specimen, with evidence of perivascular satellitosis (white arrow) (H&E, ×200). C: Evidence of perineuronal satellitosis was also noted (yellow arrow) (H&E, ×200).

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  Fig. 3 Preoperative CT scan (A) compared to postoperative CT scan (B) showed progression of edema involving the bilateral frontal lobes, now effacing most of the frontal horns of the lateral ventricles but with no signs of hemorrhage within the tumor.

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  Fig. 4 Immunohistochemical stains. A: Sample is positive for OLIG2 (×100). B: Positive for Ki-67 (×100). C: Negative for IDH1 R132H, p53, and ATRX (×100).

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