Diagnostic delay and prognosis in primary central nervous system lymphoma compared with glioblastoma multiforme

Glioblastoma multiforme (GBM) and primary central nervous system lymphoma (PCNSL) are malignant cerebral neoplasms associated with poor prognosis. Early diagnosis and subsequent planning of adequate treatment strategy are relevant to improve survival and reduce neurological deficit. Two groups of patients affected by GBM and PCNSL were compared to identify: (1) factors influencing the time necessary to obtain a correct diagnosis; (2) the influence of the interval time from clinical onset to diagnosis on the prognosis. Fifty-six patients (28 PCNSL and 28 GBM, 23 females and 33 males) referred to the same hospital setting were retrospectively evaluated. The mean age at diagnosis was 61 years. The two groups were comparable in terms of age, sex, clinical symptoms at onset and performance status. There was no relevant difference in time span from clinical onset to first neuroimaging examination, while time span from first neuroimaging to final morphological diagnosis was much longer in PCNSL patients (p = 0.008). Multivariate Cox regression analysis, including both PCNSL and GBM cases, showed a significant association of the overall survival with: time to diagnosis (HR 0.06), age at onset (HR 1.04). Our results show a significant diagnostic delay in PCNSL cases. Age at onset of disease and time to diagnosis emerge as clinical factors affecting overall survival in both groups. Stereotactic-guided biopsy should be chosen as routine method to early diagnose PCNSL. The clinical relevance of early diagnosis in GBM and PCNSL needs to be emphasized to maximize the overall survival in both neoplasms

Imaging of trigeminal neuralgia

Trigeminal neuralgia is one of the most frequent neuropathy of the cranial nerves, whose prevalence has been reported between 0.03% and 0.3% in the general population. This condition is a communal manifestation of several possible etiologies. The classical type of trigeminal neuralgia is defined as sudden, usually unilateral, severe, brief, stabbing recurrent episodes of pain in the distribution of one or more branches of the trigeminal nerve, with no cause other than a neurovascular compression. Secondary trigeminal neuralgia is the term used to group a large amount of different diseases, which are alike in developing the symptoms of trigeminal neuralgia, due to an insult to the V CN which triggers the complex pathogenesis of pain. These conditions include inflammatory diseases, infections, neoplasms, autoimmune diseases, vascular diseases other than neurovascular conflict, and treatment-related disorders. Generally, the possible mechanisms which lead to the development of neuralgia include nerve distortion/compression by an external mass or damage to the nerve fibers due to an acute or chronic insult. The radiological investigation plays a pivotal role in the diagnosis of trigeminal neuralgia, and MRI constitutes the gold imaging standard in most cases. The trigeminal nerve is a mixed sensory-motor nerve which can be divided anatomically into five segments: brainstem segment, cisternal segment, Meckel’s cave segment, cavernous sinus segment, and extracranial segment. In this paragraph, an anatomy-based imaging approach is proposed to investigate the many causes of trigeminal neuralgia, highlighting the importance of choosing the appropriate sequences and parameters, in the light of a target-suited protocol