Expert: Claes-Gustaf Nordquist, M.D. - 10/13/2009

Question
My husband had a grand mal seizure in Feb 2001 he was 39 years old. He had suregery in January 2002 for a Grade 2 Oligodendroglioma. Of course they didn't get it all. He had radiation in July of 2007. He takes depakote and Zonegran to prevent seizures and also takes lexapro and Zyprexa. He has been fine until November of last year he started losing weight his weight was 205lb and today weights 139lb. He is unable to work or drive as of July of this year. He has confusion and short term memory loss. He has no appetite.He has had a few accidents with not making it to the bathroom. The following is the results from his last MRI. the doctors told us there is nothing they can do for him and that they do not recomment Chemo or radiation. Why is he having weight loss and confusion?How long do you think he has and should I prepare? Below is his test results. Thanks Debbi
  EXAMINATION(S):
MRI BRAIN, WITH AND WITHOUT CONTRAST:
PROCEDURE: Standard MR examination of the brain performed with and
without contrast.
COMPARISON: Comparison made of MR examination 03/17/2009 and
11/24/2008.
FINDINGS: There has been no appreciable change. Again noted is
postsurgical changes in the right anterior temporal lobe from
surgical resection with cystic encephalomalacia. This, again, is
stable. There is some confluent white matter abnormality in both
cerebral hemispheres with more confluent abnormality seen in the
right parietal lobe. This is stable. Findings suggestive of
radiation therapy. Postcontrast imaging shows no evidence of
residual enhancement at the surgical bed. I see no evidence to
suggest recurrent or residual neoplasm on this exam.
No evidence of acute infarct. No evidence of acute hemorrhage. No
evidence of hydrocephalus.
IMPRESSION:
Stable examination with postsurgical changes in the right temporal
lobe with evidence of brain radiation. No new enhancement  

Answer
First of all, I'm not a neurologist or a neurosurgeon. I'm a medical oncologist & radiation therapist with experience of treating brain tumors. Your question should to a large extent be answered by a neurologist or a neurosurgeon. Probably best by a neurologist. I therefore strongly suggest that it also is directed to such an expert. It is true that there seems to be no residual tumor and no reappeared tumor and also no observable changes since the previous examinations. However that does not cover everything. Neither MRI brain scans nor CT brain scans can show any microscopic changes. So there may indeed be changes since previous examinations but on a microscopic level not observable with these methods. Also microscopic changes can result in very observable neurological, clinical and behavioral changes. And even if no tumor and no changes since previous examinations can be seen that does not mean that there is no observable pathology. On the contrary. The report clearly states that there indeed are "postsurgical changes in the right anterior (more forward part) temporal lobe from surgical resection with cystic encephalomalacia". Also "there is some confluent white matter abnormality in both cerebral hemispheres with more confluent abnormality seen in the right parietal lobe". This is probably caused by his radiation therapy. That treatment was however necessary to take care of his residual tumor. Such changes can indeed too cause neurological problems especially if they also are amplified by non observable microscopic changes. For a more detailed discussion of this problem you should consult a neurologist. Unfortunately I'm not able to (I'm not sure anybody is) provide you with any time table of future events.