Glioblastoma and Cerebral Dysfunctions

It has been a while since I want to write something on this topic because I think it is very useful for patients and their loved ones. The opportunity was given to me by reading this MSD guide, available in several languages, which offers an overview of brain function and I advise you to read or use it by consulting it to make sense of some symptoms and dysfunctions that may arise.

The brain is divided by a longitudinal sulcus into 2 hemispheres, each containing 6 separate lobes. The frontal, temporal, parietal and occipital lobes are visible on the brain surface. Although specific functions are attributed to each lobe, most activities require the coordination of multiple areas in both hemispheres. Brain function is lateralized. The visual, tactile and motor functions of the left side of the body are mainly controlled by the right hemisphere and vice versa. Some complex functions involve both hemispheres, but are predominantly controlled by one hemisphere. For example, the left hemisphere is typically dominant for language, while the right is dominant for spatial attention. A lesion present in a certain position may be associated with a potential symptom or vice versa.

In practice we know that often a Glioblastoma Multiforme can be asymptomatic and in this way it can progress without us noticing it. Sooner or later, however, the Glioblastoma will become symptomatic. Sometimes it will manifest itself through an epileptic seizure. Sometimes through some dysfunctions. Learning to recognize these dysfunctions can provide us with a lot of information on the disease and its progression and on the location of the lesions which will then be confirmed through diagnostic tests such as an MRI. Pathophysiology allows us to associate symptoms with the location of the lesion. Symptoms depend on the location, extent and speed of development of the lesion. Lesions that are <2 cm in diameter or that develop very slowly may be asymptomatic. Larger, rapidly developing lesions (over weeks or months rather than years), and lesions that simultaneously affect both hemispheres can more likely become symptomatic. Some injuries can interrupt the connection between brain areas and cause the disconnection syndrome, i.e. the inability to perform a task that requires the coordinated activity of different brain areas, despite the preservation of the fundamental functions of each area.

The possible malfunctions are:

• Agnosia which is the inability to recognize an object through one or more sensory modalities.
• Amnesia which consists in the partial or total impossibility of remembering past experiences.
• Aphasia which is a language disorder that can be characterized by an alteration in the understanding or expression of words or the non-verbal equivalents of words. It results from an altered functioning of the language centers in the cerebral cortex and in the nuclei of the base or of the connecting pathways at the level of the white matter.
• Apraxia consists in the inability to perform previously learned intentional motor tasks, despite the will and the preserved physical ability, as a consequence of brain damage.

In my experience with Emanuele, the different symptoms were then confirmed by the diagnostics but only after the time necessary to organize the exam. And time, as we know, is a determining factor in the treatment of this disease! Emanuele left 22 months ago and this year he would have been 22 years old.