We are aware of seven previous case reports in the literature describing multiple primary brain tumors in the same patient.1-5Few of these cases have been diagnosed during life, although one has been described in which both a meningioma and an adjacent oligodendroglioma were successfully removed at the time of a single operation.4In the case we are about to describe, two primary brain tumors occurred in the same patient but only one of them was diagnosed at the time of operation. The fact that the remaining tumor occurred in the opposite hemisphere made the diagnosis somewhat more difficult, and it was only at autopsy that we obtained evidence of another primary brain tumor. Although this type of double lesion is very infrequent, our purpose in reporting these tumors is not only to add another case of considerable rarity to the literature but also to stress the possibility of such a diagnosis, with the hope that in the future antemortem diagnosis and suc¬ cessful removal may be carried out, with preservation of the patient's life.A 47-year-old white man was admitted to the University Hospital complaining of righi frontal headaches. The patient was a textile worker who ior the past four months had noted generalized weakness and fatigability. Ten days prior to ad¬ mission to the hospital he had chills associated with nausea and vomiting. Al this lime his right fron¬ tal headache became more noticeable, and he was treated for possible appendicitis by his family physician, who gave him penicillin injections, lie then graduali} developed a left hemiparesis as¬ sociated with disturbed mentation and incontinence during the next few days. The headache was re¬ lieved for three days following a lumbar puncture but returned with increasing severity. On admis¬ sion, the general physical examination was essen¬ tially normal with the exception of a presystolic murmur over the precordium. The blood pressure was 144/77. with a pulse of KO a minute The patient was lethargic and showed left facial weak¬ ness of central type, left hemiparesis, a bilateral Babinski sign, nuchal rigidity, and hyperreflexia bilaterally, but more pronounced on the left. Thenwas no papilledema at this time. The visual fields were normal, although the patient cooperated poorly during the examination. It was felt that the patient had a space-taking lesion and a ventriculogram was indicateli. The ventricular fluid was found to be clear on both sides, and it was noted thai the left ventricle contained approxi¬ mately 40 cc,, whereas on the right side onlj 8-10 cc. was obtained from a more superficial tap. Three cubic centimeters of sodium indigotindisulfonate . S. P. (indigo carmine) was injected into the left ventricle and found to come out in the ventricular fluid from (he righi ventricle. Air was then injected into bolli ventricles alter drain age of all ventricular Huid. The ventriculogram showed a shift of the righi ventricle toward the left side, as well as a slight shift of the third ventricle to the left. The left ventricle was larger than the right...
