Deficits in Japanese word spelling as an initial language symptom of malignant glioma in the left hemisphere.
BACKGROUND
A good performance status at diagnosis is a prognostic factor in patients with malignant glioma whose median survival is 24 months. As early diagnosis may improve their poor prognosis, we looked for currently unknown initial symptoms among patients in good performance status.


METHODS
We chose 17 consecutive patients with malignant glioma in the left frontal and/or temporal lobe whose Karnofsky Performance Status was more than 80. At preoperative evaluation, we administered the Japanese version of the Western Aphasia Battery.


RESULTS
The chief complaint was difficulty in speech (n = 6), headache/nausea (n = 4), seizures (n = 5), and uncinate fits (n = 1); one patient was symptom-free. Of the 17 patients, 14 exhibited no motor deficits. In 15 patients, the aphasia quotient exceeded 80, indicating that the overall language deficits were mild. However, in the reading section, their scores on the "spelled kanji (Japanese ideogram) recognition" test (full score = 10) were selectively low (5.3 +/- 1.6 for right-handed individuals with frontal lesions, 6.1 +/- 1.0 for right-handed patients with temporal lesions, 7.2 +/- 2.0 for left-handed/bimanual individuals with frontal/temporal lesions). Their scores on the "spelling kanji" test were 3.0 +/- 1.6, 4.8 +/- 1.2, and 9.4 +/- 0.6, respectively.


CONCLUSIONS
Our findings point to the importance of recognizing spelling deficits as an initial symptom of left hemisphere glioma in efforts to identify patients in good performance status whose prognosis may be improved. It would be important to determine if the spelling of alphabetic words is also impaired early in the clinical course of left hemisphere glioma.
Department of Neurosurgery, Kumamoto University Medical School, Kumamoto 860-8556, Japan.
Tatsumi
T
Maeda
Tadashi
T
Hamasaki
Motohiro
M
Morioka
Teruyuki
T
Hirano
Shigetoshi
S
Yano
Hideo
H
Nakamura
Keishi
K
Makino
Jun-Ichi
J
Kuratsu
D000328:Adult; D000368:Aged; D001037:Aphasia / Q000209:etiology* / Q000473:pathology / Q000503:physiopathology; D001932:Brain Neoplasms / Q000150:complications* / Q000175:diagnosis* / Q000473:pathology; D004292:Dominance, Cerebral / Q000502:physiology; D004411:Dyslexia, Acquired / Q000209:etiology* / Q000473:pathology / Q000503:physiopathology; D042241:Early Diagnosis; D005260:Female; D005625:Frontal Lobe / Q000473:pathology / Q000503:physiopathology; D007839:Functional Laterality / Q000502:physiology; D005910:Glioma / Q000150:complications* / Q000175:diagnosis* / Q000473:pathology; D006801:Humans; D007564:Japan; D007802:Language; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D011237:Predictive Value of Tests; D011379:Prognosis; D013702:Temporal Lobe / Q000473:pathology / Q000503:physiopathology; D014705:Verbal Behavior / Q000502:physiology