The electroencephalogram in metastatic brain tumors

Pupo, P. Pinto; Pimenta, A. Mattos; Longo, Rosa Helena; Alves, A.

doi:10.1590/S0004-282X1967000400003

Abstracts

Sixty cases of intracranial metastatic tumors diagnosed either clinically or by neurosurgery (28 operative cases, 26 with radiological contrast examinations and 6 with clinical diagnosis only) are reported. The EEG tests had been made previously to the diagnosis of metastasis. The EEG results are analysed according to the previous impression gained from this test and are presented in 5 tables, on which the cases are divided as per the brain topography of the metastasis. The positive EEG data are analysed and the possibility of topographic diagnosis discussed. The results agree with those presented in the literature. The AA. reach the following conclusions: 1) in patients with suspect brain metastasis the normal EEG allows with great probability to exclude the possibility; 2) in patients with malignant tumor the EEG signs of involvement of the nervous parenchyma are the most important elements for positive diagnosis of brain metastasis; 3) in the cases of metastasis developing at the posterior fossa, either there were indicative signs of the process at that level or the EEG was normal; 4) the EEG signs of an irritant process at the brain cortex were less frequent and, in the majority of cases, appeared in the temporal and parietal areas; 5) the signs of involvement of the mesodiencephalic structures in tumors of the brain hemispheres appeared only when the tumor was located in the median part of the hemisphere (temporal or parietal lobes); 6) signs of depression of the basal electric brain activity in the affected areas appeared rarely and in cases of parietal or occipital tumors; 7) the electric brain activity of other areas of the involved hemisphere or in the opposite hemisphere was normal in the majority of the cases observed. Considering the results of the literature and their own the AA. believe that the EEG could be a semiological method to be used at the preoperative examinations of patients with malignant tumors, with a view at establishing the possible existence of brain metastasis even in the absence of clinical symptoms. The evidence is obviously most important for orientation of the therapy in such cases, whether surgical or not.

São apresentados 60 casos de tumores metastáticos intracranianos, diagnosticados clinicamente ou pela neurocirurgia (28 casos operados, 26 com exames radiológicos contrastados e 6 com diagnóstico clínico). Os exames eletrencefalográficos tinham sido feitos previamente e na mesma época do diagnóstico e da intervenção. Os resultados do EEG, interpretados previamente ao conhecimento do diagnóstico clínico, são apresentados em 5 quadros, nos quais os casos são catalogados segundo a topografia da metástase. Os dados fornecidos pelo EEG são analisados e a possibilidade do diagnóstico topográfico é discutida. Os resultados são concordantes com os da literatura. Os AA. concluem: 1) nos pacientes com suspeita de metástase cerebral o EEG normal permite, com grande probabilidade, excluir essa possibilidade; 2) nos pacientes com tumores malignos os sinais eletrencefalagráficos indicando sofrimento do parênquima nervoso são os mais importantes para um diagnóstico afirmativo de metástase cerebral; 3) nos casos de metástases desenvolvendo-se na fossa posterior o EEG se mostra normal ou, então, revela sinais indicativos de processo nessa região; 4) os sinais eletrencefalográficos de processo irritativo no córtex cerebral foram pouco frequentes e, na maioria dos casos, apareceram nas áreas temporais ou parietais; 5) os sinais de envolvimento das estruturas mesodiencefálicas em tumores dos hemisférios cerebrais aparecem nos casos de localização na parte mediana do hemisfério cerebral (lobos temporais ou parietais); 6) os sinais de depressão da ativodade elétrica cerebral de base nas áreas afetadas aparecem raramente em casos de tumores parietais ou occipitais; 7) a atividade elétrica cerebral em outras áreas do hemisfério envolvido pelo tumor e nas do hemisfério oposto se apresentou normal na maioria dos casos. Considerando os resultados da literatura e os seus próprios os AA. pensam que o EEG é um método semiológico que deva ser usado em todos os casos de pacientes com tumores malignos e candidatos a um terapêutica cirúrgica. A evidenciação de uma metástase cerebral, por este método semiológico, evitará que o paciente seja submetido a intervenção cirúrgica penosa e inútil.

The electroencephalogram in metastatic brain tumors

O eletrencefalograma nos tumores metastáticos do encéfalo

P. Pinto Pupo^I; A. Mattos Pimenta^II; Rosa Helena Longo^III; A. Alves^III

^IDepartment of Neurology and Neurosurgery of Escola Paulista de Medicina (Prof. Paulino W. Longo): Associate Professor of Neurology

^IIDepartment of Neurology and Neurosurgery of Escola Paulista de Medicina (Prof. Paulino W. Longo): Associate Professor of Neurosurgery

^IIIDepartment of Neurology and Neurosurgery of Escola Paulista de Medicina (Prof. Paulino W. Longo): Assistants

SUMMARY

Sixty cases of intracranial metastatic tumors diagnosed either clinically or by neurosurgery (28 operative cases, 26 with radiological contrast examinations and 6 with clinical diagnosis only) are reported. The EEG tests had been made previously to the diagnosis of metastasis.

The EEG results are analysed according to the previous impression gained from this test and are presented in 5 tables, on which the cases are divided as per the brain topography of the metastasis. The positive EEG data are analysed and the possibility of topographic diagnosis discussed. The results agree with those presented in the literature. The AA. reach the following conclusions: 1) in patients with suspect brain metastasis the normal EEG allows with great probability to exclude the possibility; 2) in patients with malignant tumor the EEG signs of involvement of the nervous parenchyma are the most important elements for positive diagnosis of brain metastasis; 3) in the cases of metastasis developing at the posterior fossa, either there were indicative signs of the process at that level or the EEG was normal; 4) the EEG signs of an irritant process at the brain cortex were less frequent and, in the majority of cases, appeared in the temporal and parietal areas; 5) the signs of involvement of the mesodiencephalic structures in tumors of the brain hemispheres appeared only when the tumor was located in the median part of the hemisphere (temporal or parietal lobes); 6) signs of depression of the basal electric brain activity in the affected areas appeared rarely and in cases of parietal or occipital tumors; 7) the electric brain activity of other areas of the involved hemisphere or in the opposite hemisphere was normal in the majority of the cases observed.

Considering the results of the literature and their own the AA. believe that the EEG could be a semiological method to be used at the preoperative examinations of patients with malignant tumors, with a view at establishing the possible existence of brain metastasis even in the absence of clinical symptoms. The evidence is obviously most important for orientation of the therapy in such cases, whether surgical or not.

RESUMO

São apresentados 60 casos de tumores metastáticos intracranianos, diagnosticados clinicamente ou pela neurocirurgia (28 casos operados, 26 com exames radiológicos contrastados e 6 com diagnóstico clínico). Os exames eletrencefalográficos tinham sido feitos previamente e na mesma época do diagnóstico e da intervenção.

Os resultados do EEG, interpretados previamente ao conhecimento do diagnóstico clínico, são apresentados em 5 quadros, nos quais os casos são catalogados segundo a topografia da metástase. Os dados fornecidos pelo EEG são analisados e a possibilidade do diagnóstico topográfico é discutida. Os resultados são concordantes com os da literatura.

Os AA. concluem: 1) nos pacientes com suspeita de metástase cerebral o EEG normal permite, com grande probabilidade, excluir essa possibilidade; 2) nos pacientes com tumores malignos os sinais eletrencefalagráficos indicando sofrimento do parênquima nervoso são os mais importantes para um diagnóstico afirmativo de metástase cerebral; 3) nos casos de metástases desenvolvendo-se na fossa posterior o EEG se mostra normal ou, então, revela sinais indicativos de processo nessa região; 4) os sinais eletrencefalográficos de processo irritativo no córtex cerebral foram pouco frequentes e, na maioria dos casos, apareceram nas áreas temporais ou parietais; 5) os sinais de envolvimento das estruturas mesodiencefálicas em tumores dos hemisférios cerebrais aparecem nos casos de localização na parte mediana do hemisfério cerebral (lobos temporais ou parietais); 6) os sinais de depressão da ativodade elétrica cerebral de base nas áreas afetadas aparecem raramente em casos de tumores parietais ou occipitais; 7) a atividade elétrica cerebral em outras áreas do hemisfério envolvido pelo tumor e nas do hemisfério oposto se apresentou normal na maioria dos casos.

Considerando os resultados da literatura e os seus próprios os AA. pensam que o EEG é um método semiológico que deva ser usado em todos os casos de pacientes com tumores malignos e candidatos a um terapêutica cirúrgica. A evidenciação de uma metástase cerebral, por este método semiológico, evitará que o paciente seja submetido a intervenção cirúrgica penosa e inútil.

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Full text available only in PDF format.

Department of Neurology and Neurosurgery Escola Paulista de Medicina Caixa Postal 5496 São Paulo, SP Brasil.

Paper read at the meeting of the Brasilian Society of Neurosurgery, held in Belo Horizonte, in July 1964.

1. BAGCHI, B. K: & KOOI, K. A. Electroencephalography and brain tumors. The Univ. Mich. Bull. 27:50-60, 1961.
2. BAGCHI, B. K. KOOI, K. A. SELVING, B. T. & CALHOUN, H. D. Subtentorial tumors and other lesions: an electroencephalographic study of 121 cases. EEG Clin. Neurophysiol. 13:180-92, 1961.
3. BAGCHI, B. K. & BASSET, R. C. Some additional electroencephalographic techniques for the localization of intracranial lesions. J. Neurosurg. 4:348-69, 1947.
4. BOUNES, L. & DREYFUS-BRISSAC, C. EEG des tumeurs hémisphériques intra et sous-ventriculaires. Rev. Neurol. 83:613-18, 1950.
5. CASE, Th. & BUCY, P. Localization of cerebral lesions by electroencephalography. J. Neurophysiol. 1:425-61, 1938.
6. CASE, Th. Electroencephalography in the diagnosis and localization of intracranial lesions. J. Nerv. Ment. Dis. 87:598, 1938.
7. COBB, W. A. The electroencephalographic localization of intracranial neoplasms. J. Neurol. Neurosurg. Psychiat. 7:96-102, 1944.
8. COBB, W. A. The EEG of specific lesion in Electroencephalography. A symposium on its various aspects. Denis Hill and G. Parr, 1963, p. 362.
9. CUNEO, H. M. RAND, C. W. & SJAARDEMA, H. Analysis of electroencephalographic findings in 40 cases of verified brain tumor. Bull. Los Angeles neurol. Soc. 15:22-36, 1950.
10. DALY, D. D. & THOMAS, J. E. Sequential alterations in the electroencephalograms of patients with brain tumors. EEG Clin. Neurophysiol. 10:395-404, 1958.
11. DREYFUS-BRISSAC, C; LAIREY-BOUNES, G. C; SCARPELEZOS, S. & FISCH-GOLD, H. Rythmes pathologiques détectés ŕ distance des tumeurs des hémisphéres cérébraux. Sem. Hop. Paris 26:2623-28, 1950.
12. ELLINGSON, R. J. & LUNDY, B. W. Electroencephalograms of patients suspected of having metastatic lesions of the brain. Cancer 15:1138-41, 1962.
13. FAURE, J. DROOGLEEVER-FORTUYN, J. GASTAUT, H. LARRAMENDI, L. MARTIN, P. PASSOUANT, P. RÉMOND, A. TITECA, J. & WALTER, W. G. De la génčse et de la signification des rythmes recuellis ŕ distance dans les cas de tumeurs cérébrales. EEG Clin. Neurophysiol. 3:429-32, 1951.
14. FISCHER-WILLIAMS, M. LAST, S T. LYBERI, G. & NORTHFIELD, W. C. Clinic EEG study of 128 gliomas and intracranial metastatic tumors. Brain 85:1-46, 1962.
35. GASTAUT, H. & TAMELET, J. Caractčres électrographiques directs et indirects des tumeurs hémisphériques sous-corticales. Rev. Neurol. 81:411-16, 1949.
16. GASTAUT, H. ROGER, A. & CHATRIAN, J. E. EEG findings in cases of lung cancer. EEG Clin. Neurophysiol. 6:525, 1954.
17. GREENSTEIN, I. & STRAUSS, H. Correlation between electroencephalogram and histological structures of gliogens and metastatic brain tumors. J. Mt. Sinai Hosp 12:874-77, 1945 (citation in Year Book of Neurol. Psychiat. Endocrinol., 1945, p. 85).
18. HESS, R. Elektroencephalographische Studien bei Hirntumoren. Georg Thieme Verlag, Stuttgart, 1958.
19. HOEFER, P. F. A. SCHLESINGER, E. B. & PENNES, H. H. Clinical and electroencephalographic findings in a large series of verified brain tumors. Tr. Am. Neurol. Ass. 71:52, 1946.
20. JUNG, R. Die Bedeutung des Elektrencephalograms für die Diagnostik der Hirntumoren. Regensburger Jahrbuch fur arztliche Fortbildung, 1957/58, pp. 1-15.
21. KLASS, D. W. & BICKFORD, R. G. The electroencephalogram in metastatic tumors of the brain. Neurology 8:333-37, 1958.
22. KERSHMAN, J. CONDE, A. & GIBSON, W. Electroencephalography in differential diagnosis of supratentorial tumors. Arch. Neurol. Psychiat. 62: 255-68, 1949.
23. LONGO, P. W. PUPO, P. P. PIMENTA, A. M. & LEMMI, O. Tumor da regiăo do III ventrículo: diagnóstico eletroencefalográfico. Arq. Neuro-Psiquiat. (Săo Paulo) 6:169-77, 1948.
24. LONGO, P. W. PUPO, P. P. PAZZANESE, O. & PIMENTA, A. M. Résultats éléctroencéphalographiques dans 33 cas de tumeurs intracraniennes chirurgicalement verifiées. Arq. Neuro-Psiquiat. (Săo Paulo) 8:43-46, 1950.
25. MAGNUS, O. STORM VAN LEEWEN, W. & COBB, W. Electroencephalography and cerebral tumors. EEG Clin. Neurophysiol. Supplement n.° 19, 1961.
26. MARTIN, P. & MARTIN, M. Signes éléctrographiques des tumeurs de la fosse postérieure. Rev. Neurol. 82:540-46, 1950.
27. PASSOUANT, P. CADILHAC, J. & VLAHOVITCH, B. Rythmes delta biirontaux et leurs relations avec lésion anatomique mesodiencéphalique. Rev. Neurol. 93:474-77, 1955.
28. PUECH, M. P. & LERIQUE-KOECHLIN, M. L'électroencéphalographie dans les abscčs du cerveau. Rev. Neurol. 76:303-4, 1944.
29. PUPO, P. P. & PIMENTA, A. M. A electroencefalograma nos tumores intracranianos. Arq. Neuro-Psiquiat. (Săo Paulo) 4:373-390, 1946.
30. PUPO, P. P. PAZZANESE, O. & PIMENTA, A. M. A electroencefalograma nos tumores intracranianos. Arq. Neuro-Psiquiat. _v(Săo Paulo) 6:1-24, 1948.
31. PUPO, P. P. PIMENTA, A. M. & ZUKERMAN, E. Estudo electroencefalográfico das afecçőes cirúrgicas da fossa posterior. Arq. Neuro-Psiquiat. (Săo Paulo) 12.:243-48, 1954.
32. SILVERMAN, D. & GROFF, R. A. Brain tumor depth determination by electrographic recordings during sleep. Arch. Neurol. Psychiat. 78:15-28, 1957.
33. STRANG, R. & AJMONE MARSAN, C. Brain metastasis: pathological and electroencephalographical study. Arch. Neurol. 4:21-32, 1961.
34. STORM VAN LEEWEN, W. EEG in metastatic brain tumor before, during and after radiation treatment. EEG Clinical Neurophysiol. 2:331-32, 1950.
35. TORRES, F. NETSKY, M. C. & ZIEGLER, D. K. Correlation of electroencephalographic and pathological findings in a series of metastatic brain tumors. Acta Neurol. Latino-Amer. 1:156-66, 1955.
36. VAND DER DRIFT, J. H. A. The significance of electroencephalography for diagnosis and localisation of cerebral tumors. H. S. Stenfert Krose N. V. Leiden, 1957.
37. VAN DER DRIFT, J. H. A. & MAGNUS, O. Cerebral metastasis in EEG and cerebral tumors. EEG Clin. Neurophysiol., Supplement 19, 1961, pp. 138-140.
38. WALTER W. G. The technique and applications of electroencephalography. Lancet 2:305, 1936.
39. WHITE, Ph. T. TAYLOR, R. & NELSON,, J. EEG changes associated with bronchogenic carcinoma with autopsy studies. EEG Clin. Neurophysiol. 11:842-43, 1959.

Publication Dates

Publication in this collection
21 May 2013
Date of issue
Dec 1967

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. BAGCHI, B. K: & KOOI, K. A. Electroencephalography and brain tumors. The Univ. Mich. Bull. 27:50-60, 1961.

[2] 2. BAGCHI, B. K. KOOI, K. A. SELVING, B. T. & CALHOUN, H. D. Subtentorial tumors and other lesions: an electroencephalographic study of 121 cases. EEG Clin. Neurophysiol. 13:180-92, 1961.

[3] 3. BAGCHI, B. K. & BASSET, R. C. Some additional electroencephalographic techniques for the localization of intracranial lesions. J. Neurosurg. 4:348-69, 1947.

[4] 4. BOUNES, L. & DREYFUS-BRISSAC, C. EEG des tumeurs hémisphériques intra et sous-ventriculaires. Rev. Neurol. 83:613-18, 1950.

[5] 5. CASE, Th. & BUCY, P. Localization of cerebral lesions by electroencephalography. J. Neurophysiol. 1:425-61, 1938.

[6] 6. CASE, Th. Electroencephalography in the diagnosis and localization of intracranial lesions. J. Nerv. Ment. Dis. 87:598, 1938.

[7] 7. COBB, W. A. The electroencephalographic localization of intracranial neoplasms. J. Neurol. Neurosurg. Psychiat. 7:96-102, 1944.

[8] 8. COBB, W. A. The EEG of specific lesion in Electroencephalography. A symposium on its various aspects. Denis Hill and G. Parr, 1963, p. 362.

[9] 9. CUNEO, H. M. RAND, C. W. & SJAARDEMA, H. Analysis of electroencephalographic findings in 40 cases of verified brain tumor. Bull. Los Angeles neurol. Soc. 15:22-36, 1950.

[10] 10. DALY, D. D. & THOMAS, J. E. Sequential alterations in the electroencephalograms of patients with brain tumors. EEG Clin. Neurophysiol. 10:395-404, 1958.

[11] 11. DREYFUS-BRISSAC, C; LAIREY-BOUNES, G. C; SCARPELEZOS, S. & FISCH-GOLD, H. Rythmes pathologiques détectés ŕ distance des tumeurs des hémisphéres cérébraux. Sem. Hop. Paris 26:2623-28, 1950.

[12] 12. ELLINGSON, R. J. & LUNDY, B. W. Electroencephalograms of patients suspected of having metastatic lesions of the brain. Cancer 15:1138-41, 1962.

[13] 13. FAURE, J. DROOGLEEVER-FORTUYN, J. GASTAUT, H. LARRAMENDI, L. MARTIN, P. PASSOUANT, P. RÉMOND, A. TITECA, J. & WALTER, W. G. De la génčse et de la signification des rythmes recuellis ŕ distance dans les cas de tumeurs cérébrales. EEG Clin. Neurophysiol. 3:429-32, 1951.

[14] 14. FISCHER-WILLIAMS, M. LAST, S T. LYBERI, G. & NORTHFIELD, W. C. Clinic EEG study of 128 gliomas and intracranial metastatic tumors. Brain 85:1-46, 1962.

[15] 35. GASTAUT, H. & TAMELET, J. Caractčres électrographiques directs et indirects des tumeurs hémisphériques sous-corticales. Rev. Neurol. 81:411-16, 1949.

[16] 16. GASTAUT, H. ROGER, A. & CHATRIAN, J. E. EEG findings in cases of lung cancer. EEG Clin. Neurophysiol. 6:525, 1954.

[17] 17. GREENSTEIN, I. & STRAUSS, H. Correlation between electroencephalogram and histological structures of gliogens and metastatic brain tumors. J. Mt. Sinai Hosp 12:874-77, 1945 (citation in Year Book of Neurol. Psychiat. Endocrinol., 1945, p. 85).

[18] 18. HESS, R. Elektroencephalographische Studien bei Hirntumoren. Georg Thieme Verlag, Stuttgart, 1958.

[19] 19. HOEFER, P. F. A. SCHLESINGER, E. B. & PENNES, H. H. Clinical and electroencephalographic findings in a large series of verified brain tumors. Tr. Am. Neurol. Ass. 71:52, 1946.

[20] 20. JUNG, R. Die Bedeutung des Elektrencephalograms für die Diagnostik der Hirntumoren. Regensburger Jahrbuch fur arztliche Fortbildung, 1957/58, pp. 1-15.

[21] 21. KLASS, D. W. & BICKFORD, R. G. The electroencephalogram in metastatic tumors of the brain. Neurology 8:333-37, 1958.

[22] 22. KERSHMAN, J. CONDE, A. & GIBSON, W. Electroencephalography in differential diagnosis of supratentorial tumors. Arch. Neurol. Psychiat. 62: 255-68, 1949.

[23] 23. LONGO, P. W. PUPO, P. P. PIMENTA, A. M. & LEMMI, O. Tumor da regiăo do III ventrículo: diagnóstico eletroencefalográfico. Arq. Neuro-Psiquiat. (Săo Paulo) 6:169-77, 1948.

[24] 24. LONGO, P. W. PUPO, P. P. PAZZANESE, O. & PIMENTA, A. M. Résultats éléctroencéphalographiques dans 33 cas de tumeurs intracraniennes chirurgicalement verifiées. Arq. Neuro-Psiquiat. (Săo Paulo) 8:43-46, 1950.

[25] 25. MAGNUS, O. STORM VAN LEEWEN, W. & COBB, W. Electroencephalography and cerebral tumors. EEG Clin. Neurophysiol. Supplement n.° 19, 1961.

[26] 26. MARTIN, P. & MARTIN, M. Signes éléctrographiques des tumeurs de la fosse postérieure. Rev. Neurol. 82:540-46, 1950.

[27] 27. PASSOUANT, P. CADILHAC, J. & VLAHOVITCH, B. Rythmes delta biirontaux et leurs relations avec lésion anatomique mesodiencéphalique. Rev. Neurol. 93:474-77, 1955.

[28] 28. PUECH, M. P. & LERIQUE-KOECHLIN, M. L'électroencéphalographie dans les abscčs du cerveau. Rev. Neurol. 76:303-4, 1944.

[29] 29. PUPO, P. P. & PIMENTA, A. M. A electroencefalograma nos tumores intracranianos. Arq. Neuro-Psiquiat. (Săo Paulo) 4:373-390, 1946.

[30] 30. PUPO, P. P. PAZZANESE, O. & PIMENTA, A. M. A electroencefalograma nos tumores intracranianos. Arq. Neuro-Psiquiat. _v(Săo Paulo) 6:1-24, 1948.

[31] 31. PUPO, P. P. PIMENTA, A. M. & ZUKERMAN, E. Estudo electroencefalográfico das afecçőes cirúrgicas da fossa posterior. Arq. Neuro-Psiquiat. (Săo Paulo) 12.:243-48, 1954.

[32] 32. SILVERMAN, D. & GROFF, R. A. Brain tumor depth determination by electrographic recordings during sleep. Arch. Neurol. Psychiat. 78:15-28, 1957.

[33] 33. STRANG, R. & AJMONE MARSAN, C. Brain metastasis: pathological and electroencephalographical study. Arch. Neurol. 4:21-32, 1961.

[34] 34. STORM VAN LEEWEN, W. EEG in metastatic brain tumor before, during and after radiation treatment. EEG Clinical Neurophysiol. 2:331-32, 1950.

[35] 35. TORRES, F. NETSKY, M. C. & ZIEGLER, D. K. Correlation of electroencephalographic and pathological findings in a series of metastatic brain tumors. Acta Neurol. Latino-Amer. 1:156-66, 1955.

[36] 36. VAND DER DRIFT, J. H. A. The significance of electroencephalography for diagnosis and localisation of cerebral tumors. H. S. Stenfert Krose N. V. Leiden, 1957.

[37] 37. VAN DER DRIFT, J. H. A. & MAGNUS, O. Cerebral metastasis in EEG and cerebral tumors. EEG Clin. Neurophysiol., Supplement 19, 1961, pp. 138-140.

[38] 38. WALTER W. G. The technique and applications of electroencephalography. Lancet 2:305, 1936.

[39] 39. WHITE, Ph. T. TAYLOR, R. & NELSON,, J. EEG changes associated with bronchogenic carcinoma with autopsy studies. EEG Clin. Neurophysiol. 11:842-43, 1959.