Emotional lability as a symptom of extra-axial posterior fossa tumours : a case-control review of neuroanatomy and patient-reported quality of life
Bibliographic record
Abstract
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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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.007 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.004 | 0.003 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".