Expert: Claes-Gustaf Nordquist, M.D. - 2/9/2008

Question
I have a 96 year old grandma who recently had a CT scan. Results say "diffuse cerebral atrophy", "extensive small vessel ischemic change in the supratentorial white matter bilaterally, most likely choronic in nature" and "a rounded enhansing nodule at the right aspect of the falx anteriorly in the frontal lobe region measuring 12-mm AP x 8-mm transversely. Compatable with a right parafalcine meningioma. Do not identify evidence of significant mass effect or edema within the adjacent right frontal lobe.

Can you help to decifer this for me? I gather it means she has a brain tumor. Any other input would be helpful. Her short-term memory is terrible, she has had some delusions and paranoia, confusion, not eating well, fecal incontinance, swelling in legs and feet and is irratable. Still has fairly good long-term memory and moments of clarity. Often unrealistic about what she is capable of and refuses family or medical intervention. She still lives on her own. I have noticed her mental decline over the past 1 1/2 years, especially the past few months. Help!

Answer
Yes she has a SMALL benign (non cancerous) brain tumor, a meningioma. It is of NO consequence to her general, neurological or mental condition. And it is not of great medical concern here and now - nor probably for the future! The important thing here is that she suffers from senile and ateriosclerotic dementia as showed by the fact that her brain has shrunk and that there are signs of blood vessel disease resulting in a declined blood supply to her brain. There may also be some effects of a so called low pressure hydrocephalus due to a decreased circulation of cerebrospinal fluid. Anyway her mental problems as you describe them support the evidence of the CT scan. A patient in this condition should not live alone but be taken care of in a nursing home or a similar facility! She is certainly NOT capable of taking care of her own affairs!