Emotional lability as a symptom of extra-axial posterior fossa tumours : a case-control review of neuroanatomy and patient-reported quality of life
Notice bibliographique
Résumé
Introduction: Emotional lability (EL), the uncontrollable and unmotivated expression of emotion, is a rare and distressing symptom of brainstem compression from extra-axial posterior fossa tumours. In published case reports, EL is alleviated by surgical resection of the tumour. The primary goal of this study was to radiographically compare the degree of compression from mass lesions onto brainstem structures between EL cases and matched controls. The secondary goal was to compare changes in patient reported quality of life (QOL) pre- and post-operatively. Methods: In a retrospective review of patients treated for posterior fossa tumours with brainstem compression between 2002 and 2018 at Vancouver General Hospital, 11 patients with confirmed EL were identified. Each case was matched to 3 controls. Pre-operative axial T2-weighted FLAIR MRI scans were reviewed, and a lateral brainstem compression scale was used to characterize the degree of mass effect at the level of the medulla, pons, and midbrain. Compression was compared between EL patients and control patients. Clinical variables were also compared. Patients routinely complete the Short form-36 (SF36v1) general health survey at clinic appointments, these surveys were retrospectively obtained from patient charts. Pre- versus post-operative changes in survey scores were compared between EL patients and controls. Results: EL symptoms ceased post-operatively for all EL patients. EL tumours exert greater compression onto the pons (EL mean compression score=2.91, control mean compression score=1.91, one-tailed p=0.03). EL patients more commonly have cerebellar findings (p=0.003) pre-operatively. Patients with EL-causing tumours experienced greater improvement post-operatively in “Health Change” (two-tailed p=0.05), which was maintained over time. Control patients experienced greater improvement in the “Role Limitations Due to Physical Health” SF36v1 sub-score (two-tailed p=0.03), which was not maintained over time. Conclusion: This is the largest case series to-date investigating adult extra-axial posterior fossa tumours that cause EL. Findings suggest that compression onto the pons inhibits control over involuntary, stereotyped expression of emotion This adds to evidence that EL may be attributed to deafferentation of the cerebellum from cortical and limbic structures through the basis pontis, leading to impaired modulation of emotional response. The QOL results augment benefits of obtaining EL-alleviating surgery.
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Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,001 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,004 | 0,001 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,001 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».