Dubey Souvik, Ghosh Ritwik, Chatterjee Subhankar, Dubey Mahua Jana, Sengupta Samya, Chatterjee Subham, Kanti Ray Biman, Modrego Pedro J, Benito-León Julián
Department of Neuromedicine, Bangur Institute of Neurosciences, Kolkata, India.
Department of General Medicine, Burdwan Medical College and Hospital, Burdwan, India.
Case Rep Oncol. 2021 Mar 3;14(1):325-332. doi: 10.1159/000513744. eCollection 2021 Jan-Apr.
Brain tumors have long been considered one of the most prevalent causes of potentially reversible cognitive impairment. An accurate underlying cause of cognitive impairment due to brain tumor needs to be evaluated pragmatically. Patterns of cognitive impairment associated with brain tumors depend mainly on their location, lateralization, pathological classification and secondary effects of the treatment, as well as the structural plasticity and diaschisis. Hence, it is not rare that lesions with different locations and histologies may manifest with a similar pattern of cognitive impairment due to the complex interplay of determinants. We herein report 3 patients with brain tumors affecting different locations and with differing histologies, who shared a similar presentation as "frontal dysexecutive syndrome" masqueraded as psychiatric conditions. Detailed examination of saccades and pursuit along with eye movements and conventional motor examinations were essential not only to diagnose brain tumor as the potential cause of cognitive impairment, but also to rule out other coexisting etiologies with completely different underlying pathological mechanisms (i.e., Huntington's disease in 1 of the cases). A detailed neurological examination, including eye movement assessment, in patients with psychiatric symptoms provides not only important clues to delineate the underlying anatomical substrate involved, but also helps clinicians to make an accurate diagnosis and to select appropriate therapeutic options.
脑肿瘤长期以来一直被认为是潜在可逆性认知障碍的最常见原因之一。需要切实评估脑肿瘤导致认知障碍的准确潜在原因。与脑肿瘤相关的认知障碍模式主要取决于其位置、脑半球优势、病理分类和治疗的继发效应，以及结构可塑性和远隔功能障碍。因此，由于多种决定因素的复杂相互作用，不同位置和组织学类型的病变可能表现出相似的认知障碍模式，这种情况并不罕见。我们在此报告3例脑肿瘤患者，肿瘤位置和组织学类型各不相同，但都表现出类似“额叶执行功能障碍综合征”的症状，且被误诊为精神疾病。详细检查扫视和跟踪以及眼球运动和传统运动检查，不仅对于诊断脑肿瘤作为认知障碍的潜在原因至关重要，而且对于排除其他具有完全不同潜在病理机制的共存病因（例如，其中1例为亨廷顿舞蹈病）也至关重要。对有精神症状的患者进行详细的神经系统检查，包括眼球运动评估，不仅为确定所涉及的潜在解剖学基础提供重要线索，而且有助于临床医生做出准确诊断并选择合适的治疗方案。
