Expert: Claes-Gustaf Nordquist, M.D. - 9/16/2010

Question
QUESTION: What can you tell me about Idiopathic Intracranial Pressure in relation to an intramedullary astrocytoma?  My husband has all the symptoms of suffering from intracranial pressure without hydrocephalus and nothing shows on a brain MRI, but he has a thoracic astrocytoma.  If this is what is causing those symptoms what is the prognosis?  Thank you so much for your help.

ANSWER: I suppose that he has an astrocytoma in the thoracic part of his spinal cord. Correct? Well the brain and the spinal cord more or less float in the circulating cerebro-spinal fluid. An astrocytoma is like every other tumor an expanding process. So by growing it may disturb the circulation of this fluid. The skull and the spinal canal together form an almost completely closed off space. So based on these 2 facts it is quite possible that his tumor by disturbing the circulation within this closed space may cause an increased pressure within his skull which is the result you see in a case of hydrocephalus. However if that is the case in his case it can not be called one caused by Idiopathic Increased Intracranial Pressure since such cases are those where the causes of the condition are completely unknown. That does not seem to be the case here since we do have a possible and even probable cause. Like all malignant tumors of the central nervous system (brain & spinal cord) the prognosis of his tumor is not good. That would be the case even without these symptoms. How big is his tumor?




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QUESTION: It is from the C8 to the T4 with a possible syrinx associated.  My husband and the doctors do not want to treat it and we have had difficulty with the doctors here accepting that the intracranial symptoms are related to the intramedullary tumor.  He has constant nausea, dizziness and headaches though and is also suffering from aphasia and visual disturbances.  He also has all the standard spinal tumor symptoms as well and is in constant extreme pain that medication does not help.  They believe it is a diffuse astrocytoma.  With these symptoms and continuing to leave it untreated, what kind of a timeframe are we looking at and how will it progress?

Answer
Well, I can not be certain that there is a connection. All I see is a possibility. You should discuss this with a neurologist or a neurosurgeon who may be much better qualified to evaluate this. It is also too big for the stereotactic radiation therapy I was considering. These other neurological symptoms you describe do make his situation even more mysterious. You have to discuss this with a neurologist.




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