Analysis of causes for late presentation of Indian patients with vestibular schwannoma

Ambett, Ranjeeta; Rupa, Vedantam; Rajshekhar, Vedantam

doi:10.1017/s0022215108003575

Cited by 8 publications

(3 citation statements)

References 15 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In developing countries, other factors such as economic standards, as well as patient and physician awareness, can affect such referrals. Correspondingly, a recent article from India reported a delay between an initial medical consultation for CPA tumors and the final diagnosis to range from 1 to 204 months (9). In the present study, the mean delay for the referral of VS cases was 15.5 months, and this interval was primarily the result of patient delay.…”

Section: Discussionsupporting

confidence: 51%

Prospective Evaluation of the Clinical Profile and Referral Pattern Differences of Vestibular Schwannomas and Other Cerebellopontine Angle Tumors

Ragab¹,

Emara²,

Shouker³

et al. 2012

Otology &Amp; Neurotology

View full text Add to dashboard Cite

show abstract

Section: Discussionsupporting

confidence: 51%

Prospective Evaluation of the Clinical Profile and Referral Pattern Differences of Vestibular Schwannomas and Other Cerebellopontine Angle Tumors

Ragab¹,

Emara²,

Shouker³

et al. 2012

Otology &Amp; Neurotology

View full text Add to dashboard Cite

show abstract

“…Most previous studies of the diagnostic pathway have focused on very specific tumour types, e.g. vestibular schwannoma ( 20 ), intradural spinal cord tumours ( 21 ), pituitary adenomas ( 21 ), acoustic neuromas ( 22 ), central nervous lymphomas ( 23 ) or intracranial germ cell tumours ( 24 ) (e.g. 23 , 25 , 26 ).…”

Section: Discussionmentioning

confidence: 99%

Symptoms in primary care with time to diagnosis of brain tumours

et al. 2018

View full text Add to dashboard Cite

BackgroundBrain tumours often present with varied, non-specific features with other diagnoses usually being more likely.ObjectiveTo examine how different symptoms and patient demographics predict variations in time to brain tumour diagnosis.MethodsWe conducted a secondary analysis of brain tumour cases from National Audit of Cancer Diagnosis in Primary Care. We grouped neurological symptoms into six domains (headache, behavioural/cognitive change, focal neurology, ‘fits, faints or falls’, non-specific neurological, and other/non-specific) and calculated times for patient presentation, GP referral, specialist consultation and total pathway interval. We calculated odds ratios (ORs) for symptom domains comparing the slowest to other quartiles.ResultsData were available for 226 cases. Median (interquartile range) time for the total pathway interval was 24 days (7–65 days). The most common presentation was focal neurology (33.2%) followed by ‘fits, faints or falls’ and headache (both 20.8%). Headache only (OR = 4.11, 95% CI = 1.10, 15.5) and memory complaints (OR = 4.82, 95% CI = 1.15, 20.1) were associated with slower total pathway compared to ‘fits, faints or falls’. GPs were more likely to consider that there had been avoidable delays in referring patients with headache only (OR = 4.17, 95% CI = 1.14, 15.3).ConclusionPatients presenting to primary care with headache only or with memory complaints remain problematic with potentially avoidable delays in referral leading to a longer patient pathway. This may or may not impact on the efficacy and morbidity of therapies. Additional aids are required to help doctors differentiate when to refer headaches and memory complaints urgently for a specialist opinion.

show abstract

“…These arguments are in concordance with the observations highlighted in one Indian study. 15 Developing world's neurosurgeons encounter and operate mostly large or giant tumors, with the outcomes destined poor, compared with the western literature. The results of our study also highlight the significantly higher incidence of visual loss in patients from remote areas and with a longer duration of symptoms.…”

Section: Discussionmentioning

confidence: 99%

Preoperative Visual Impairment in Vestibular Schwannoma Patients: An Overlooked Entity of Developing World

et al. 2022

View full text Add to dashboard Cite

Objective Visual impairment in vestibular schwannomas is an underreported entity. The plethora of literature focuses primarily on facial and hearing preservation. This study aims to describe our experience and find the possible reasons for visual impairment. Materials and Methods This is a retrospective observational study. We evaluated 114 patients with vestibular schwannoma, operated during 2015 to 2020. Eight parameters were studied—age, gender, maximum tumor size, hydrocephalus, economic status, duration of symptoms, visual loss, and ease of access to the tertiary neurosurgical facility. JASP software (version 0.14.1, Amsterdam) was used for statistical analysis. Results A total of 42/114 (36.84%) patients had a varying degree of impairment. Patients with impaired vision had significantly larger tumors (4.31 vs. 4.12 cm, p = 0.02), longer duration of symptoms (19.14 vs. 16.45 months, p = 0.02), hydrocephalus (p = 0.03), and were from remote areas (p = 0.009). In stepwise logistic regression analysis, longer duration of symptoms and difficult access to neurosurgical facility stand out as decisive factors for visual impairment. The follow-up data were available for 35/42 (83.33%) cases of visual impairment. Vision improved in 14/35 (40%) of cases. Vision improved in a significantly higher number of patients when a preoperative ventriculoperitoneal shunt was placed (p = 0.03). Conclusion The visual handicap occurs in a significant number of patients with vestibular schwannoma. Delayed arrival at the neurosurgical facility due to difficult access appears to be the primary factor leading to blindness. Strengthening our healthcare systems in rural areas would go a long way in the timely detection and prevention of blindness in such cases.

show abstract

Analysis of causes for late presentation of Indian patients with vestibular schwannoma

Cited by 8 publications

References 15 publications

Prospective Evaluation of the Clinical Profile and Referral Pattern Differences of Vestibular Schwannomas and Other Cerebellopontine Angle Tumors

Prospective Evaluation of the Clinical Profile and Referral Pattern Differences of Vestibular Schwannomas and Other Cerebellopontine Angle Tumors

Symptoms in primary care with time to diagnosis of brain tumours

Preoperative Visual Impairment in Vestibular Schwannoma Patients: An Overlooked Entity of Developing World

Contact Info

Product

Resources

About