Diagnosis: Brain Tumor - AS

A 19-year-old man presented to a physician in the spring of 1991 when he experienced continuous headaches and weakness. He was given some analgesics that provided no improvement. After loosing consciousness, he was taken to the emergency room of Social Security's Goztepe Hospital (S.S.K. Goztepe Hastanesi). He was transferred to the neurosurgery clinic. The computed tomography (CT) scan performed on 21 May 1991 with and without contrast revealed a large enhancing mass in the left parietal region with large amount of surrounding edema with mass effect shifting the midline structures to the right. There was a second enhancing lesion in the right cerebellum ( Appendix AS1 ). Magnetic resonance imaging (MRI) documented the same tumors on 31 May 1991 ( Appendix AS2 ). Although the possibility that the lesions might be due to an infectious disease was considered, the general impression was that they were metastases ( Appendix AS3 ). Anti edema treatment was applied, and the patient gained partial consciousness. The patient was discharged with a recommendation of anti edema therapy, and high dose of third generation cephalosporin ( Appendix AS3 and Appendix AS4 )

The patient was taken to Dr. Ozel on 26 August 1991. He could not feel nor move his right arm and leg. He had speech (diffuculty in finding and pronouncing words) and visual (he saw things in doubles) disorders, and sharp, continuous headache. Arterial blood pressure was 120/80 mm Hg. He had been taking Deltacortril pills (four times daily), and Fomadin. Since the patient was using cortisone, no rise in fever was expected after N.O.I. injections. He was placed on a regiment with 1cc dose of N.O.I. to be given daily six times per week, and 3x0.5 cc of N.O.O. to be administered three times every day.

The relatives reported on 15 November 1991 that the patient's general condition had improved, that the paralysis of the right arm and leg had partially resolved.

MR images obtained on 4 December 1991 ( Appendix AS5 ) demonstrated that the lesions in the left parietal site and right cerebellum continued to exist, but the mass effect and the shift had improved from 31 May 1991 with less mass effect.

The patient presented to Dr. Ozel on 24 June 1992 with MR images obtained on 27 May 1992. His consciousness was back to normal, he had no visual disturbance. He had traveled without company, and this was a good sign of his recovery. The paralysis in the right arm and leg had resolved by 75%. MRI ( Appendix AS6 ) showed that the tumor in the left parietal regressed, and its pressure lessened. The tumor in the right cerebellum had decreased in size as well. The patient was recommended to carry on N.O. treatment as previously recommended.

MR images obtained on 13 November 1992 demonstrated remarkable regression of the tumor in the left parietal region, and no significant mass effect ( Appendix AS7 ). The tumor in the right cerebellum had disappeared almost completely. The patient's regimen was changed to one 1cc dose of N.O.I. to be given every two days, 0.5cc dose of N.O.O. to be administered three times daily.

Medical counsel of Social Security's Goztepe Hospital issued a statement on 18 December 1992 allowing the patient to go back to work ( Appendix AS8 ).

Another MRI scan performed on 27 May 1993 revealed continued improvement in the left parietal mass with no mass effect or compression of the underlying ventricle ( Appendix AS9 ). The right cerebellar lesion was no longer identified.

Electroencephalography performed on 15 September 1993 demonstrated no finding that might be related to a cortical lesion or epileptiform. Bioelectrical activity of the brain was found to be sufficient ( Appendix AS10 )

CT scan performed on 18 October 1993 showed only a small area of encephalomalacia in the left parietal region ( Appendix AS11 ). The patient was recommended to stop N.O. treatment.

Follow up MR images obtained on 10 October 1996 demonstrated no lesion in the left parietal region and in the right cerebellum. ( Appendix AS12 ).

He last visited Dr. Ozel in June 2008; he was in remission.