title: Intractable vomiting as an early clinical symptom of cerebrospinal fluid seeding to the fourth ventricle in patients with high-grade astrocytoma.
abstract: OBJECTIVE
  Cerebrospinal fluid (CSF) seeing of high-grade astrocytoma is common, but the early clinical symptoms are not well characterized. Here, we report five patients with disseminated high-grade astrocytoma in the fourth ventricle region who presented with intractable vomiting prior to the detection of the metastatic deposits with enhancement.
  
  
  METHODS
  From 1994 to 2000, 133 patients of high-grade astrocytoma were treated in our institute and were followed up until December 2002. Follow-up magnetic resonance (MR) imaging was performed in all patients every 2-3 months. The CSF seeding was defined as leptomeningeal enhancement. Signs and symptoms of CSF seeding were checked at the monthly outpatient examination.
  
  
  RESULTS
  Among them, 5 patients aged from 27 to 58 years (mean 43.8 years) with one anaplastic astrocytoma and four glioblastomas showed intractable vomiting without signs of high intracranial pressure as evaluated by MR imaging or ocular fundus examination prior to the detection of the fourth ventricle dissemination. Fourth ventricle dissemination appeared 1-3 months after vomiting in five patients. One patient with glioblastoma received gamma knife radiotherapy for a fourth ventricle lesion appearing as a high intensity area on T2-weighted imaging before the appearance of the enhanced nodule, and this lesion was cured. Four patients died of progression of the fourth ventricle lesion.
  
  
  CONCLUSIONS
  Intractable vomiting may be an early clinical symptom of CSF seeding to the fourth ventricle in patients with high-grade astrocytoma. Early detection and immediate radiotherapy for this lesion are recommended to control fourth ventricle dissemination.
authors.affiliation: Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan.
authors.forename: Miki
authors.initials: M
authors.lastname: Fujimura
authors.forename: Toshihiro
authors.initials: T
authors.lastname: Kumabe
authors.forename: Hidefumi
authors.initials: H
authors.lastname: Jokura
authors.forename: Reizo
authors.initials: R
authors.lastname: Shirane
authors.forename: Takashi
authors.initials: T
authors.lastname: Yoshimoto
authors.forename: Teiji
authors.initials: T
authors.lastname: Tominaga
mesh_terms: D000328:Adult; D001254:Astrocytoma / Q000134:cerebrospinal fluid* / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D001932:Brain Neoplasms / Q000134:cerebrospinal fluid* / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D017809:Fatal Outcome; D005260:Female; D020546:Fourth Ventricle / Q000473:pathology; D005909:Glioblastoma / Q000134:cerebrospinal fluid / Q000150:complications; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009366:Neoplasm Seeding; D014839:Vomiting / Q000209:etiology*