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Washington University Experience | NEOPLASM (SELLAR) | Craniopharyngioma, adamantinomatous | 1A0 Case 1 History
Case 1 History ---- The decedent was a 6 year old male with a past medical history of a suprasellar adamantinomatous craniopharyngioma, status-post subtotal resection in February 2013, followed at that time by radiation treatment targeted to the neoplasm. His course was complicated by cystic growth of the residual mass (requiring fenestration in 2014), bilateral painless vision loss (treated with left subfrontal craniotomy and optic nerve decompression in January 2015), left transverse sinus venous thrombosis with punctate areas of restricted diffusion in the left corpus callosum and left posterior frontal lobe, consistent with acute infarcts (noted on radiological imaging), panhypopituitarism, diabetes insipidus, central hypothyroidism, secondary adrenal insufficiency, and hypothalamic obesity. He developed hydrocephalus with bilateral subdural fluid collections (hygromas) that had been very difficult to treat; he had had an external subdural drain on the left, subsequently converted to a subdural to peritoneal shunt. He developed a seizure disorder that was treated with Keppra therapy. His prior treatments had resulted in fairly significant global developmental delay. ---- He was in SLCH in January 2016 after missing a dose of hydrocortisone. On that admission he had hypoglycemia with electrolyte and blood gas abnormalities, including hypernatremia. His head CT and EEG were unchanged from priors. In February 2016, he had a seizure at home requiring EMS who arrived after 10 minutes and found him pulseless and in asystole. CPR was initiated during transport by EMS. Blood glucose at that time was <20. CPR was unsuccessful.
