The Impact of Social Determinants of Health on the Diagnosis of Anaplastic Oligodendroglioma: A Case Report
Keywords:
oligodendroglioma, Social Determinants of Health, SDOH in healthcare, Diagnosis, multilingualism, Aphasia, Geriatrics, Bilingual patient, Brain tumor diagnosisAbstract
Background:
Anaplastic oligodendroglioma is a rare central nervous system neoplasm, accounting for 0.5% of all primary brain tumors. It is derived from oligodendrocytes and is typically located in the frontal lobes of the brain. Since its clinical manifestations are non-specific, many patients present with months to years of symptoms before receiving a diagnosis. Expressive aphasia in bilingual patients can be especially challenging to identify. Thus, it is critical for health care providers to recognize social determinants of health to establish a diagnosis of anaplastic oligodendroglioma and avoid delays in care.
The Case:
A 75-year-old bilingual woman presented to a routine Cardiology appointment and reported word finding difficulties that worsened over the past 6 months. Five months later at her visit with Geriatrics, she reported more recent issues with expressive aphasia in both English and Spanish and difficulty speaking that started 1-2 years prior. A brain MRI revealed a left frontal lobe mass. Patient underwent a brain biopsy, which identified an IDH-mutant, 1p/19p co-deleted WHO-III anaplastic oligodendroglioma.
Conclusion:
Assessing social determinants of health such as language can help physicians diagnose medical conditions presenting with non-specific symptoms. In this case, the diagnosis of expressive aphasia was delayed likely because patient’s symptoms were attributed to lack of English proficiency. After careful examination and identifying her symptoms as aphasia in a bilingual patient, a work-up led to the diagnosis of anaplastic oligodendroglioma. Physicians should be aware of the social determinants of health and how they affect individual patients to avoid diagnostic biases.
Metrics
References
Santosh V, Rao S. A review of adult-type diffuse gliomas in the WHO CNS5 classification with special reference to Astrocytoma, IDH-mutant and Oligodendroglioma, IDH-mutant and 1p/19q codeleted. Indian Journal of Pathology and Microbiology. 2022;65(Suppl 1).
Bou Zerdan M, Assi HI. Oligodendroglioma: A Review of Management and Pathways. Front Mol Neurosci. 2021;14:722396.
Velnar T, Smrdel U, Popovic M, Bunc G. Genetic markers in oligodendroglial tumours. Radiol Oncol.
;44(1):13-8.
Furst T, Hoffman H, Chin LS. All-cause and tumor-specific mortality trends in geriatric oligodendroglioma (OG) patients: A surveillance, epidemiology, and end results (SEER) analysis. Journal of Clinical Neuroscience. 2020;73:94-100.
Jimenez AE, Cicalese KV, Chakravarti S, Porras JL, Azad TD, Jackson CM, et al. Social determinants of health and the prediction of 90-day mortality among brain tumor patients. J Neurosurg. 2022;137(5):1338-46.
Wick W, Roth P, Hartmann C, Hau P, Nakamura M, Stockhammer F, et al. Long-term analysis of the NOA-04 randomized phase III trial of sequential radiochemotherapy of anaplastic glioma with PCV or temozolomide. Neuro Oncol. 2016;18(11):1529-37.
Alther B, Mylius V, Weller M, Gantenbein AR. From first symptoms to diagnosis: Initial clinical presentation of primary brain tumors. Clinical and Translational Neuroscience. 2020;4(2):2514183X20968368.
Behrens M, Thakur N, Lortz I, Seifert V, Kell CA, Forster M-T. Neurocognitive deficits in patients suffering from glioma in speech-relevant areas of the left hemisphere. Clinical Neurology and Neurosurgery. 2021;207:106816.
Scimeca M, Abdollahi F, Penaloza C, Kiran S. Clinical perspectives and strategies for confronting
disparities in social determinants of health for Hispanic bilinguals with aphasia. J Commun Disord.
;98:106231.
Lekoubou A, Gleichgerrcht E, McGrattan K, Bachman DL, Adams RJ, Bonilha L. Aphasia in
multilingual individuals: the importance of bedside premorbid language proficiency assessment.
eNeurologicalSci. 2015;1(1):1-2.
Goral M, Hejazi Z. Aphasia in Multilingual Patients. Curr Neurol Neurosci Rep. 2021;21(11):60.
Paradis M. Principles underlying the Bilingual Aphasia Test (BAT) and its uses. Clinical Linguistics & Phonetics. 2011;25(6-7):427-43.
Rivera Perla KM, Tang OY, Durfey SNM, Vivas-Buitrago T, Sherman WJ, Parney I, et al. Predicting
access to postoperative treatment after glioblastoma resection: an analysis of neighborhood-level
disadvantage using the Area Deprivation Index (ADI). J Neurooncol. 2022;158(3):349-57.
Curry WT, Jr., Carter BS, Barker FG, 2nd. Racial, ethnic, and socioeconomic disparities in patient
outcomes after craniotomy for tumor in adult patients in the United States, 1988-2004. Neurosurgery.
;66(3):427-438.
Downloads
Published
How to Cite
Issue
Section
Categories
License
Copyright (c) 2025 Meghan Acheson, Brendan H. Pulsifer, Jorge Garcia Peña

This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors who publish with this journal agree to the following terms:
- The Author retains copyright in the Work, where the term “Work” shall include all digital objects that may result in subsequent electronic publication or distribution.
- Upon acceptance of the Work, the author shall grant to the Publisher the right of first publication of the Work.
- The Author shall grant to the Publisher and its agents the nonexclusive perpetual right and license to publish, archive, and make accessible the Work in whole or in part in all forms of media now or hereafter known under a Creative Commons Attribution 4.0 International License or its equivalent, which, for the avoidance of doubt, allows others to copy, distribute, and transmit the Work under the following conditions:
- Attribution—other users must attribute the Work in the manner specified by the author as indicated on the journal Web site; with the understanding that the above condition can be waived with permission from the Author and that where the Work or any of its elements is in the public domain under applicable law, that status is in no way affected by the license.
- The Author is able to enter into separate, additional contractual arrangements for the nonexclusive distribution of the journal's published version of the Work (e.g., post it to an institutional repository or publish it in a book), as long as there is provided in the document an acknowledgment of its initial publication in this journal.
- Authors are permitted and encouraged to post online a prepublication manuscript (but not the Publisher’s final formatted PDF version of the Work) in institutional repositories or on their Websites prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work. Any such posting made before acceptance and publication of the Work shall be updated upon publication to include a reference to the Publisher-assigned DOI (Digital Object Identifier) and a link to the online abstract for the final published Work in the Journal.
- Upon Publisher’s request, the Author agrees to furnish promptly to Publisher, at the Author’s own expense, written evidence of the permissions, licenses, and consents for use of third-party material included within the Work, except as determined by Publisher to be covered by the principles of Fair Use.
- The Author represents and warrants that:
- the Work is the Author’s original work;
- the Author has not transferred, and will not transfer, exclusive rights in the Work to any third party;
- the Work is not pending review or under consideration by another publisher;
- the Work has not previously been published;
- the Work contains no misrepresentation or infringement of the Work or property of other authors or third parties; and
- the Work contains no libel, invasion of privacy, or other unlawful matter.
- The Author agrees to indemnify and hold Publisher harmless from the Author’s breach of the representations and warranties contained in Paragraph 6 above, as well as any claim or proceeding relating to Publisher’s use and publication of any content contained in the Work, including third-party content.
Enforcement of copyright
The IJMS takes the protection of copyright very seriously.
If the IJMS discovers that you have used its copyright materials in contravention of the license above, the IJMS may bring legal proceedings against you seeking reparation and an injunction to stop you using those materials. You could also be ordered to pay legal costs.
If you become aware of any use of the IJMS' copyright materials that contravenes or may contravene the license above, please report this by email to contact@ijms.org
Infringing material
If you become aware of any material on the website that you believe infringes your or any other person's copyright, please report this by email to contact@ijms.org