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Washington University Experience | NEOPLASM (SELLAR) | Craniopharyngioma, adamantinomatous | 3A0 Case 3 History
Case 3 History ---- The patient was a 71 year old male with a long history of treated hypertension. Because of difficulty with incontinence, the patient had a prostatectomy. After the operation, the patient developed an elevated BUN and creatinine. Further surgery corrected this and they returned to normal. Six months before admission in 1974, he had an elevated BUN and elevated creatinine caused by a UTI and was treated with tetracycline. ---- The patient was admitted with an apparent cerebral infarct in October 1975. As part of the workup of his CVA there was a suggestion of a right field cut on gross examination. A skull X-ray showed a calcification in the suprasellar area. A brain scan showed an asymmetrical distribution of activity suggestive of cerebral vascular disease. EMI scan showed a calcified mass overlying the dorsum sella obliterating the anterior 3rd ventricle and elevating the anterior horn of the lateral ventricle. It did not enhance with contrast. His final course began with several episodes of a clotted renal dialysis shunt. On neurologic examination a Marcus-Gunn pupil on the right with optic atrophy on the right were noted. The patient was acutely confused and disoriented. There were bilateral Babinski signs and weakness. Mental status did not improve in spite of dialysis. On the 31st of December, multifocal seizures were noted, but not further described. On the 1st of January, he was declared dead. There was neither definitive thrombosis of the circle of Willis or cerebral infarct identified at autopsy.
