2. NEOPLASMS - TEMPORAL LOBE GLIOMA
A Sample Case: At first the patient was troubled by the fact that he didnít know how he ended up at a distant bus stop far from his home but finally dismissed the thought. He had also payed little attention to a spate of headaches during the last several months. At home he asked his wife about the source of the smell of cabbage but she responded that she wasnít cooking and that she couldnít smell anything unusual. She then noticed that he was making grimacing faces which included lip-smacking and swallowing. He went to the TV set but did nothing but stare above it. His wife recognized that something was wrong but none of her queries to him were met by reasonable responses. In about 15 mins he returned to his chair and his responses to his wife became normal. However, he did not acknowledge his odd behavior when his wife told him of it though he had a vague recollection of a strange odor.
At the hospital this 40 yr old man appeared perfectly normal with respect to mental status. Cranial nerves were normal except for an upper left quadrantic anopsia. Other sensory and motor findings were normal.
His wifeís description of his short-lived actions including the olfactory hallucination and lack of memory of the event suggest seizure activity. Combined with chewing, lip movements, and swallowing the seizure suggests a focus in the olfactory-related areas of the medial and inferior aspect of the temporal lobe.
While the seizure activity described is suggestive of the lobe involved, i.e., temporal, the visual loss indicates more precisely the side and location of the lesion. The homonymous left-sided visual field loss indicates a post-chiasmal lesion on the right. Optic radiation fibers of the superior visual fields loop far forward into the temporal lobe. EEG studies also confirmed abnormalities that were consistent with a lesion of the anterior-medial pole of the temporal lobe.
The history of headache preceding the other signs suggested the slow growth of a space-taking mass which was confirmed by MRI. Biopsy indicated a glioma.