OJMN  Vol.4 No.2 , April 2014
Dystextia: An Early Sign of Pregnancy-Associated Meningioma
Objective: The authors report a case of meningioma causing incomprehensible and excessive text messaging in a postpartum woman. Case Report: We report the case of expressive dystextia related to a postpartum, progesterone receptor-positive meningioma. Growth of meningiomas can accelerate during pregnancy and the postpartum period due to expression of hormone receptors, particularly progesterone. This is the first study describing dystextia related to a brain tumor; previous cases of dystextia are associated with stroke and complex migraine. Here expressive dystextia, the inability to compose syntactically comprehensible text messages, preceded acute neurologic signs by several months, and surgical resection of the meningioma eliminated all neurologic sequelae. Possible genetic etiologies for meningioma are discussed since this patient’s prior thyroid cancer at age 18 suggests a relationship between the two neoplasms. Conclusions: Since text messaging is becoming one of the principal forms of communication in our society and requires both cognitive and motor skills, clinicians should be aware that dystextia may be the initial sign of significant neurologic pathology. We propose that an inquiry about altered text messaging frequency and comprehensibility should be a standard part of the neurologic evaluation.

Cite this paper
Hannah, J. , Kissel, P. , Russell, B. and Hose, J. (2014) Dystextia: An Early Sign of Pregnancy-Associated Meningioma. Open Journal of Modern Neurosurgery, 4, 69-75. doi: 10.4236/ojmn.2014.42015.
[1]   Cawood, T.J. (2006) Dystextia—A Sign of the Times? Irish Medical Journal, 99, 157.

[2]   Ravi, A., Rao, V.R. and Klein, J.P. (2013) Dystextia: Acute Stroke in the Modern Age. Archives of Neurology, 70, 404. http://dx.doi.org/10.1001/jamaneurol.2013.604

[3]   Burns, B. and Randall, M. (2013) “Dystextia”: Onset of Difficulty Writing Mobile Phone Texts Determines the Time of Acute Ischaemic Stroke Allowing Thrombolysis. Practical Neurology, 509. http://dx.doi.org/10.1136/practneurol-2013-000509

[4]   Whitfield, P. and Jayathissa, S. (2011) Evolving Neurological Terminology in the 21st Century: “Dystextia” Associated with Complex Migraine. Internal Medicine Journal, 41, 646.

[5]   Chamoun, R., Krisht, K.M. and Couldwell, W.T. (2011) Incidental Meningiomas. Neurosurgical Focus, 31, 1-7. http://dx.doi.org/10.3171/2011.9.FOCUS11220

[6]   Cohen-Gadol, A.A., Friedman, J.A., Friedman, J.D., Tubbs, R.S., Munis, J.R. and Meyer, F.B. (2009) Neurosurgical Management of Intracranial Lesions in the Pregnant Patient: A 36-Year Institutional Experience and Review of the Literature. Journal of Neurosurgery, 111, 1150-1157.

[7]   Cowppli-Bony, A., Bouvier, G., Rue, M., Loiseau, H., Vital, A., Lebailly, P., et al. (2011) Brain Tumors and Hormonal Factors: Review of the Epidemiological Literature. Cancer Causes and Control, 22, 697-714. http://dx.doi.org/10.1007/s10552-011-9742-7

[8]   Kasper, E.M., Hess, P.E., Silasi, M., Lim, K.-H., Gray, J., Reddy, H., et al. (2010) A Pregnant Female with a Large Intracranial Mass: Reviewing the Evidence to Obtain Management Guidelines for Intracranial Meningiomas during Pregnancy. Surgical Neurology International, 1, 95.

[9]   Smith, J.S., Quinones-Hinojosa, A., Harmon-Smith, M., Bollen, A. and McDermott, M.W. (2005) Sex Steroid and Growth Factor Profile of a Meningioma Associated with Pregnancy. Canadian Journal of Neurological Sciences, 32, 122-127.

[10]   Wiemels, J., Wrensch, M. and Claus, E.B. (2010) Epidemiology and Etiology of Meningioma. Journal of Neuro-Oncology, 99, 307-314. http://dx.doi.org/10.1007/s11060-010-0386-3

[11]   Choy, W., Kim, W., Nagasawa, D., Stramotas, S., Yew, A., Gopen, Q., et al. (2011) The Molecular Genetics and Tumor Pathogenesis of Meningiomas and the Future Directions of Meningioma Treatments. Neurosurgical Focus, 30, E6.

[12]   Ragel, B.T. and Jensen, R.L. (2005) Molecular Genetics of Meningiomas. Neurosurgical Focus, 19, E9. http://dx.doi.org/10.3171/foc.2005.19.5.10

[13]   Hsu, D.W., Efird, J.T. and Hedley-Whyte, E.T. (1997) Progesterone and Estrogen Receptors in Meningiomas: Prognostic Considerations. Journal of Neurosurgery, 86, 113-120.

[14]   Roser, F., Nakamura, M., Bellinzona, M., Rosahl, S.K., Ostertag, H. and Samii, M. (2004) The Prognostic Value of Progesterone Receptor Status in Meningiomas. Journal of Clinical Pathology, 57, 1033-1037. http://dx.doi.org/10.1136/jcp.2004.018333

[15]   Gazzeri, R., Galarza, M. and Gazzeri, G. (2007) Growth of a Meningioma in a Transsexual Patient after Estrogen-Progestin Therapy. New England Journal of Medicine, 357, 2411-2412.

[16]   Vadivelu, S., Sharer, L. and Schulder, M. (2010) Regression of Multiple Intracranial Meningiomas After Cessation of Long-Term Progesterone Agonist Therapy. Journal of Neurosurgery, 112, 920-924.

[17]   Vernooij, M.W., Ikram, M.A., Tanghe, H.L., Vincent, A.J.P.E., Hofman, A., Krestin, G.P., et al. (2007) Incidental Findings on Brain MRI in the General Population. New England Journal of Medicine, 357, 1821-1828. http://dx.doi.org/10.1056/NEJMoa070972

[18]   Baxter, D.S., Smith, P., Stewart, K. and Murphy, M. (2009) Clear Cell Meningioma Presenting as Rapidly Deteriorating Visual Field and Acuity During Pregnancy. Journal of Clinical Neurosciences, 16, 1502-1504. http://dx.doi.org/10.1016/j.jocn.2009.02.008

[19]   Khong, S.Y., Leach, J. and Greenwood, C. (2007) Meningioma Mimicking Puerperal Psychosis. Obstetrics & Gynecology, 109, 515-516. http://dx.doi.org/10.1097/01.AOG.0000226856.21741.3f

[20]   Calado, S. and Viana-Baptista, M. (2006) Benign Cerebral Angiopathy; Postpartum Cerebral Angiopathy: Characteristics and Treatment. Current Treatment Options in Cardiovascular Medicine, 8, 201-212. http://dx.doi.org/10.1007/s11936-006-0013-y

[21]   Singhal, A.B. and Bernstein, R.A. (2005) Postpartum Angiopathy and Other Cerebral Vasoconstriction Syndromes. Neurocritical Care, 3, 91-97. http://dx.doi.org/10.1385/NCC:3:1:091

[22]   Coe, J.E.L. and Oakhill, J.V. (2011) “txtN is ez f u no h2 rd”: The Relation between Reading Ability and Text-Messaging Behaviour. Journal of Computer Assisted Learning, 27, 4-17.

[23]   Tyler, L.K., Marsien-Wilson, W.D., Randall, B., Wright, P., Devereux, B.J., Zhuang, J., et al. (2011) Left Inferior Frontal Cortex and Syntax: Function, Structure and Behaviour in Patients with Left Hemisphere Damage. Brain, 134, 415-431. http://dx.doi.org/10.1093/brain/awq369

[24]   Fewings, P.E., Battersby, R.D. and Timperley, W.R. (2000) Long-Term Follow Up of Progesterone Receptor Status in Benign Meningioma: A Prognostic Indicator of Recurrence? Journal of Neurosurgery, 92, 401-405. http://dx.doi.org/10.3171/jns.2000.92.3.0401

[25]   Barg, E., Godzinski, J., Wikiera, B., Gtab, E. and Jelen, M. (2009) Papillary Thyroid Carcinoma and Meningioma in 17-Year-Old Boy—A Late Effect of Acute Lymphoblastic Leukemia Treatment or a New Disease? Case Report and Literature Review. Pediatric Endocrinology, Diabetes & Metabolism, 15, 51-54.

[26]   Brassesco, M.S., Valera, E.T., Neder, L., Pezuk, J.A., Oliviera, R.S., Scrideli, C.A., et al. (2012) Cytogenetic Findings in Pediatric Radiation-Induced Atypical Meningioma after Treatment of Medulloblastoma: Case Report and Review of the Literature. Journal of Neuro-Oncology, 110, 397-402. http://dx.doi.org/10.1007/s11060-012-0982-5

[27]   Chaturvedi, S., Gupta, S. and Kumari, R. (2010) Meningioma with Metastasis from Follicular Carcinoma Thyroid. Indian Journal of Pathology & Microbiology, 53, 316-318. http://dx.doi.org/10.4103/0377-4929.64298

[28]   Claus, E.B., Calvocoressi, L., Bondy, M.L., Schildkraut, J.M., Wiemels, J.L. and Wrensch, M. (2011) Family and Personal Medical History and Risk of Meningioma. Journal of Neurosurgery, 115, 1072-1077. http://dx.doi.org/10.3171/2011.6.JNS11129

[29]   Sughrue, M.E., Kane, A.J., Shangari, G., Parsa, A.T., Berger, M.S. and McDermott, M.W. (2010) Prevalence of Previous Extracranial Malignancies in a Series of 1228 Patients Presenting with Meningioma. Journal of Neurosurgery, 113, 1115-1121. http://dx.doi.org/10.3171/2010.3.JNS091975

[30]   Asgharian, B., Chen, Y.-J., Patronas, N.J., Peghini, P.L., Reynolds, J.C., Vortmeyer, A., et al. (2004) Meningiomas May be a Component Tumor of Multiple Endocrine Neoplasia Type 1. Clinical Cancer Research, 10, 869-880. http://dx.doi.org/10.1158/1078-0432.CCR-0938-3

[31]   Gutmann, D.H., Donahoe, J., Perry, A., Lemke, N., Gorse, K., Kittiniyou, K., et al. (2000) Loss of DAL-1, a Protein 4.1-Related Tumor Suppressor, Is an Important Early Event in the Pathogenesis of Meningiomas. Human Molecular Genetics, 9, 1495-1500. http://dx.doi.org/10.1093/hmg/9.10.1495

[32]   Perry, A., Can, D.X., Scheithauer, B.W., Swanson, P.E., Lohse, C.M., Newsham, I.F., et al. (2000) Merlin, DAL-1, and Progesterone Receptor Expression in Clinicopathologic Subsets of Meningioma: A Correlative Immunohistochemical Study of 175 Cases. Journal of Neuropathology & Experimental Neurology, 59, 782-879.