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Washington University Experience | NEOPLASMS (EMBRYONAL) | Medulloblastoma, Histologically Defined | Classic Subtype | 6 A0 Case 6 History
Case 6 History ---- The patient was a 21 year old female admitted following a 1 yr history of progressive ataxia, dysarthria, and dysphagia, and a 1 month history of headache and vomiting. She suffered a cardiopulmonary arrest on the 2nd day of hospitalization and expired 2 days later. The patient was well until June of 1978, while pregnant, she had the sudden onset of dizziness and poor balance. These symptoms progressed even after she delivered, and in September 1978 she was admitted to Barnes Hospital. Examination showed an ataxic gait, dysarthria, and left cerebellar signs. The CT. scan, lumbar puncture and CSF oligoclonal bands were all normal. Her discharge diagnosis was multiple sclerosis. Throughout the next 6 months her symptoms gradually progressed and in February 1979 she was re-admitted after out-patient steroid treatment offered no improvement. EEG, lumbar puncture, visual evoked response, auditory evoked response, and CT scan were all normal, although some enhancement of the vermis was noticed on the post-contrast CT scan. Over the next 6 months the patient continued to deteriorate and was no longer able to walk. One month prior to admission she developed an increasingly severe occipital headache, and intractable vomiting with a 30 lb. weight loss. Two weeks prior to admission she began complaining of diplopia, dysarthria, and dysphagia. On admission she was a thin pale woman who complained frequently of a severe headache. Pulse was 84, respirations 18, blood pressure 116/96. Grade 4 papilledema was present bilaterally. Her intellect seemed intact, although her speech was quite dysarthric and scanning. There was bilateral horizontal nystagmus; a mild left lateral rectus weakness was questioned. The gag was decreased on the right. Strength was intact, although there was some drift of the left arm when it was held outstretched. Titubation of the head, and a resting tremor of the extremities were present. There was a marked intention tremor of all extremities greater on the left than the right. Ocular dysmetria was also noted. Myotatic reflexes were normal; Babinski reflexes were present bilaterally. A CT scan showed a contrast enhancing mass of the cerebellar vermis extending up to the quadrigeminal cistern, obliterating the 4th ventricle, and infiltrating the cerebellar peduncles. A ventriculostomy was placed and showed an opening pressure of 200, CSF glucose 104, protein 11, and 85 red blood cells. On the morning following admission, while waiting in the X-ray suite for arteriography, she experienced a sudden cardiorespiratory arrest culminating with fixed dilated pupils and absent brain stem function. Hemorrhagic fluid began emerging from the ventriculostomy; a repeat CT scan showed blood in the ventricles and surrounding the cerebellar mass. She was maintained on a respirator without any return of neurologic function for the next two days. She was pronounced dead after a cardiac arrest in October 1979.
