Spinal Drop Metastasis of Glioblastoma-Two Case Reports, Clinicopathologic Features, Current Modalities of Evaluation, and Treatment with a Review of the Literature.

BACKGROUND: Glioblastomas (World Health Organization grade IV) are aggressive primary neoplasms of the central nervous system. Spinal metastasis occurs supposedly in 2%-5% of patients. This percentage may be only the tip of iceberg because most succumb to the disease before clinical detection and few documented cases are reported. CASE DESCRIPTIONS: A 45-year-old man presented with history of diplopia and gait disturbance. Magnetic resonance imaging showed a left cerebellar space-occupying lesion. The histopathology was consistent with glioblastoma. The patient underwent adjuvant chemoradiation. A year later, he presented with seizures, worsening headache, neck stiffness, and low back pain. Imaging showed metastasis to the S1/S2 region of the spinal canal. A 29-year-old man presented with episodic headaches associated with nausea, vomiting, neck stiffness, and imbalance while walking. Computed tomography of the brain showed a hypodense lesion involving the left midbrain, pons, and left middle cerebellar peduncle, causing fourth ventricular pressure with obstructive hydrocephalus. A navigation-guided biopsy of the brainstem lesion confirmed the diagnosis of glioblastoma World Health Organization grade IV, isocitrate dehydrogenase 1 (R132 H) and H3K27M negative. Isocitrate dehydrogenase gene sequencing was suggested. The patient was referred for chemoradiation. During treatment, he worsened neurologically and developed axial neck and back pain. Neuraxis screening showed disseminated leptomeningeal spread, which was confirmed on dural biopsy. CONCLUSIONS: Spinal and dural metastasis should always be suspected in patients with glioblastoma with signs and symptoms not explained by primary lesion. A regular protocol with postcontrast magnetic resonance imaging before and after initial surgery is mandatory to detect spinal metastasis before it becomes clinically apparent, thereby improving the prognosis and quality of life in patients.

Assessment of anterior segment parameters under photopic and scotopic conditions in Indian eyes using anterior segment optical coherence tomography.

PURPOSE: To compare the anterior segment parameters in photopic and scotopic conditions using anterior segment optical coherence tomography (AS OCT) in Indian eyes. MATERIALS AND METHODS: One hundred eyes of 100 normal subjects of both sexes, aged 19 to 76 years, underwent anterior segment evaluation by AS OCT (Visante OCT). Central corneal thickness (CCT), central anterior chamber depth (ACD), pupil diameter (PD) and the temporal and nasal peripheral irido-corneal angles were assessed in photopic and scotopic conditions. These anterior segment parameters were stratified for age, sex and refractive error. RESULTS: Mean values of the parameters measured in photopic and scotopic conditions respectively were as follows: ACD (mm) 2.88 +/- 0.32, 2.89 +/- 0.32 (P = 0.10); nasal angle (degrees) 28.80 +/- 5.91, 22.28 +/- 7.50 (P < 0.001); temporal angle (degrees) 29.95 +/- 6.74, 22.82 +/- 8.43 (P < 0.001); pupil diameter (mm) 4.08 +/- 0.91, 4.68 +/- 0.92 (P < 0.001); CCT (microm) 519 +/- 33.88, 519 +/- 33.88. CONCLUSIONS: There was no significant difference in the ACD in photopic and scotopic conditions. While the nasal and temporal angles showed a significant decrease, the pupil diameter showed a significant increase in scotopic conditions. Mean central ACD decreased with age and was shallower in females than in males. It was highest in myopes and lowest in hypermetropes. CCT was not influenced by photopic and scotopic conditions.

Optic disc topography of normal Indian eyes: an assessment using optical coherence tomography.

PURPOSE: To study the optic disc topographic measurements of normal Indian eyes using optical coherence tomography (OCT). MATERIALS AND METHODS: One hundred and fifty eyes selected randomly from 150 normal Indian subjects of both sex and various age groups underwent optic disc imaging with the OCT using the fast optic disc protocol. RESULTS: Mean +/- standard deviation of the optic disc topographic measurements were: disc area 2.63 +/- 0.55 mm 2 , cup area 0.87 +/- 0.45 mm 2 , neuroretinal rim area 1.78 +/- 0.55 mm 2 and cup to disc area ratio 0.33 +/- 0.15. There was no significant difference in the measurements between males and females. There was no significant correlation with respect to age and refractive errors ranging from -5.0 to +3.0 diopters of spherical equivalent. CONCLUSION: Our study provides a normative database for the various optic disc topographic measurements and its variations with age, sex and refractive error in normal Indian eyes using OCT.