The Impact of Social Determinants of Health on the Diagnosis of Anaplastic Oligodendroglioma: A Case Report

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.