UBC Theses and Dissertations
Emotional lability as a symptom of extra-axial posterior fossa tumours : a case-control review of neuroanatomy and patient-reported quality of life Prakash, Swetha
Introduction: Emotional lability (EL), the uncontrollable and unmotivated expression of emotion, is a rare and distressing symptom of brainstem compression from extra-axial posterior fossa tumours. In published case reports, EL is alleviated by surgical resection of the tumour. The primary goal of this study was to radiographically compare the degree of compression from mass lesions onto brainstem structures between EL cases and matched controls. The secondary goal was to compare changes in patient reported quality of life (QOL) pre- and post-operatively. Methods: In a retrospective review of patients treated for posterior fossa tumours with brainstem compression between 2002 and 2018 at Vancouver General Hospital, 11 patients with confirmed EL were identified. Each case was matched to 3 controls. Pre-operative axial T2-weighted FLAIR MRI scans were reviewed, and a lateral brainstem compression scale was used to characterize the degree of mass effect at the level of the medulla, pons, and midbrain. Compression was compared between EL patients and control patients. Clinical variables were also compared. Patients routinely complete the Short form-36 (SF36v1) general health survey at clinic appointments, these surveys were retrospectively obtained from patient charts. Pre- versus post-operative changes in survey scores were compared between EL patients and controls. Results: EL symptoms ceased post-operatively for all EL patients. EL tumours exert greater compression onto the pons (EL mean compression score=2.91, control mean compression score=1.91, one-tailed p=0.03). EL patients more commonly have cerebellar findings (p=0.003) pre-operatively. Patients with EL-causing tumours experienced greater improvement post-operatively in “Health Change” (two-tailed p=0.05), which was maintained over time. Control patients experienced greater improvement in the “Role Limitations Due to Physical Health” SF36v1 sub-score (two-tailed p=0.03), which was not maintained over time. Conclusion: This is the largest case series to-date investigating adult extra-axial posterior fossa tumours that cause EL. Findings suggest that compression onto the pons inhibits control over involuntary, stereotyped expression of emotion This adds to evidence that EL may be attributed to deafferentation of the cerebellum from cortical and limbic structures through the basis pontis, leading to impaired modulation of emotional response. The QOL results augment benefits of obtaining EL-alleviating surgery.
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