[Meningioma in the aged--on its differential diagnosis (author's transl)]

Despite vast improvement in diagnostic techniques in neurosurgery during the past few decades, there still remain a significant number of intracranial tumors in geriatric age group, which are not recognized in the early course of the disease or during life. We are now focusing on the diagnostic problems of meningiomas in the geriatric age group and stressing the significant value of brain scanning in the differential diagnosis of brain tumors from cerebral vascular disease or other conditions. During about 10-year period, a total of 36 intracranial tumours in cases over 60 year old have been studied. Sixteen of these tumors are meningiomas and form the basis of this report. The age of these cases was between 60 and 83 years with average of 70.5. There were two males and 14 females. As to the location, four were parsagittal and falx meningiomas, three were at tuberculum sellae, two were at sphenoidal ridge, one was at tentorium in location. Twelve cases were erroniously diagnosed and confusion with cerebrovascular disease was most common. We analysed the onset and the progression of symptoms of our 16 cases, and picked up and stressed the four peculiarities of geriatric meningiomas. The first one is that the onset of symptoms is very sudden, almost precipitate, and the subsequent clinical course may be so rapidly progressive. The six patients in our cases were included in this group. A case among those was verified to be complicated with intratumoral hemorrhage, and another one with a subdural hematoma. The vast contrast to the first group is the second peculiarity. The meningioma especially in the geriatric age group may frequently unfold a clinical picture, which by its very insidious onset and slow development may be even unrecognized during life. The third is that patients developed dementia, at the onset in two cases and in any course of this disease in six. All too frequently in these instances the tumor has been overlooked and wrongly diagnosed as a senile dementia or psychosis. The fourth is that the meningioma developed with intermittent, recurrent and streotyped cerebral symptoms including epilepsy. We presented a case with intermittent aphasia due to a convexity meningioma on the dominant side. In almost all cases, manifestation of increased intracranial pressure was absent or not significant. There was found a papilledema in only one case, and cerebrospinal fluid revealed a normal pressure in six out of eight cases in which lumbar puncture was performed. It was proved that brain scanning was one of the most useful adjuncts in the diagnosis of brain tumor in the aged even in serious conditions. Changing brain scan patterns in association with clinical course is a useful diagnostic guide in differentiating tumors from cerebrovascular accidents. The serial scan density change is more meaningful if the clinical course is considered. Scanning should be done as soon as possible when the brain tumor is suspected and should be rescanned if necessary.