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Washington University Experience | NEOPLASMS (GLIAL) | Angiocentric glioma | 1A0 Case 1 History
Case 1 History ---- The patient was a 7-year-old boy with a history of epilepsy, a radiologically-diagnosed cortical abnormality and Chiari type 1 malformation. A brain MRI performed in July of 2011 demonstrated an abnormal T2 / FLAIR focus over the left posterior parietal lobe (clinical DDx DNET vs. focal cortical dysplasia). The patient was admitted to SLCH for status epilepticus in November 2011 and for Neisseria meningitidis in Jan/Feb 2012. In April 2014 he developed a generalized tonic-clonic activity treated with Diastat which abated seizure activity. On arrival to the ER, he had shallow respirations and was intubated but had no further seizure activity. After successful management of his airway difficulties, he was discharged. In August 2014, the patient had a generalized tonic-clonic seizure, EMS responded, and Versed was administered intranasally at an OSH. He had respiratory depression and ongoing seizure activity. He subsequently vomited, aspirated, and developed bradycardia with arrest. CPR was initiated with recovery 30 minutes later. He was intubated and given Ativan and Keppra. He had marked lactic acidosis, received multiple boluses of sodium bicarbonate and calcium glucose as part of his resuscitation and was transferred to SLCH. On arrival to the SLCH ICU, he was intubated and unresponsive. His pupils were dilated and fixed without doll's eye, cough, or gag reflexes. His family proceeded with redirection of care and he died on August 24. ---- At autopsy the weight of the unfixed brain was 1660g. A firm, well-circumscribed, gray-tan mass extended from the leptomeningeal surface and displaced/infiltrated the underlying cortical ribbon. There was also an incidental arachnoid cyst involving the left posterior parieto-occipital cortex immediately adjacent to the solid mass.
