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Washington University Experience | MYELIN (IMMUNE-MEDIATED) | ADEM | 6A0 Case 6 History
Case 6 History ---- The patient is a 23-year-old woman with a history of MRSA skin abscesses and Clostridium difficile infection following wrist fracture surgery. She presented with severe headache, altered mental status, nausea, and vomiting. She was initially diagnosed at an outside hospital with urinary tract infection for which she received antibiotics. She also had fever and leukocytosis. However, her status continued to decline and she was found to have tremor concerning for seizure activity. She also developed right hemiplegia as well as aphasia. CT and MRI showed a left frontal intracranial lesion. She was transferred to our hospital for further management. CT chest/abdomen/pelvis showed multiple liver lesions, one of which was biopsied at an outside hospital resulting in a diagnosis of an epithelioid hemangioendothelioma. MRI showed an infiltrative FLAIR signal abnormality centered in the left frontal lobe with peripheral enhancement, with interval progression from the previous study 2 days prior. She was found to have left gaze deviation and fluctuating pupil abnormality. Operative procedure: Left decompressive hemicraniectomy and open brain biopsy.
