Seizure leads to brain tumor diagnosis

Coordinated care surrounds patient from diagnosis, treatment to recovery

Darlene O'Brian was enjoying the trip of a lifetime when, seemingly out of the blue, she had a seizure. The 73-year-old Shellsburg woman had never had one before. Darlene was wrapping up the week-long trip to Ireland with her husband, Larry, daughter, Denise and son-in-law, Brian, when she had the seizure. The year was 2011.

"We were enjoying our lunch," recalled Darlene. "There was really no warning that anything was wrong and I suddenly had a seizure. After it passed we went back to our hotel room so I could rest.

I am diabetic so we thought maybe it was related to that, coupled with jet lag." Darlene said she felt fine and had no other episodes. A short time after Darlene returned home she had a routine check-up with Julie Hoffmann, a nurse practitioner at UnityPoint Clinic - Shellsburg. "Darlene mentioned she had a seizure in Ireland," said Hoffmann. "She wondered if the episode was caused by her blood sugar. I told her I did not think it was related to her diabetes and suggested she get a CT scan."

"I had the CT scan and was told the doctor saw a mass," said Darlene. "I was then sent for an MRI, so the doctors could get a better image and determine what it was they were seeing."
A computed tomography or CT scan uses X-rays to create pictures of certain areas of the body. An MRI (magnetic resonance imaging) is a way to take pictures of sections of the body using a magnetic field and pulses of radio wave energy.

"I had to tell Darlene over the phone that the doctors saw something," recalled Hoffmann. "I don't like to deliver this type of news over the phone but she wanted to know right away. I remember telling her it could be a benign tumor and that we would get her in to see Dr. Mary Hlavin, a UnityPoint Clinic neurosurgeon as soon as it was possible to find out what the mass was."

"I typically see these patients within 24 hours of when I am contacted by their doctor," said Dr. Hlavin. "I want to get them in here, talk about what I see and discuss treatment options."

Unexpected diagnosis

"Dr. Hlavin was wonderful to us," said Larry O'Brian, Darlene's husband. "She sat down with our family and explained that Darlene had a meningioma brain tumor, which had formed outside of her brain. Dr. Hlavin told us it was most likely benign. It was unexpected news."

"This type of brain tumor has a certain look and typical appearance," said Dr. Hlavin. "The vast majority of meningioma tumors are benign. Over 25 percent of individuals ages 65 and older may have one of these tumors and not know it. And if they have no symptoms they may never know it exists."

Dr. Hlavin said there are typically three treatment options for individuals with a meningioma brain tumor. If the tumor is relatively small and isn't causing issues, observation is recommended. A second option is surgery if the tumor is causing problems, as it was in Darlene's case. And radiation therapy may be a third option if a surgeon isn't able to remove the entire tumor or if the tumor is in a spot where surgery is not safe.

"Darlene's tumor was about three centimeters," said Dr. Hlavin. "I had some initial concerns about her tumor because it looked like it might be invading the skull. After some discussion we decided surgery to remove the tumor was the best route."

"We felt grateful Julie Hoffmann put us in touch with Dr. Hlavin and that she was going to remove the tumor," said Larry. "Dr. Hlavin put us at ease and let us know she had done this surgery many times. We felt completely confident in her skills and think a lot of her as a person."

Successful surgery

The surgery was a success and Dr. Hlavin was able to remove most of Darlene's tumor. Darlene stayed in a private room at St. Luke's for about three days. "I had great care," said Darlene. "Dr. Hlavin did an excellent job in removing the tumor and putting me at ease. The nurses were great. I felt the care was so well coordinated."

In accordance with state law Darlene was restricted from driving for six months because of the seizure and she had routine follow-up MRIs to make sure the tumor didn't return. "A small percentage of patients will have tumor regrowth so we monitor the patient for a period of time. It has been about two years since her surgery and I would say Darlene is doing great. There has been no regrowth and we're down to yearly MRIs. Reoccurrences are uncommon."

Coordinated care

"Having Dr. Hlavin as a resource in our community is great," said Hoffmann. "And being part of the UnityPoint Health system helps streamline the coordination of care between her office, our clinic and the hospital. As Darlene's primary care provider I am kept in the loop and know what is being done for her and how I may follow-up to provide further support."

"I feel good," said Darlene. "I am very grateful to Julie for sending me to get that CT scan when I thought the seizure was probably nothing. I am happy with the great care I received from Dr. Hlavin. It was so well coordinated and I felt like my care was always in great hands." UnityPoint Clinic healthcare providers put their patients at the center of everything they do, they collaborate as a team and surround patients with care that is coordinated between the patient's doctor's office, hospital and their home.

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