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Washington University Experience | NEOPLASMS (GLIAL) | Astrocytoma, pilocytic - Gross Pathology | 5A0 Case 5 History
Case 5 History ---- This patient was a 9 year old female with a history of pilocytic astrocytoma. A VP shunt was placed at age 4 for hydrocephalus of unknown etiology, atypical Raynaud's phenomenon diagnosed in April, 1998, and attention deficit disorder since age 5. Pilocytic astrocytoma was diagnosed in July 1998 when MRI of the head and spine revealed a large posterior fossa lesion widely disseminated within the CSF space, and entirely encasing the spinal cord. The patient received two courses of Vincristine/Carboplatin chemotherapy and then completed a six-week course of radiation therapy in November 1998. Since the diagnosis of CNS tumor, the patient's status worsened with development of hypertension, seizures, bilateral lower extremity paralysis, and neurogenic bowel and bladder. Two days after completing radiation therapy, the patient had an acute onset of dyspnea. She presented to an outside hospital with a normal chest x-ray and low oxygen saturations. She was admitted there overnight, then transported to SLCH where she required 12 L of oxygen by non-rebreather face mask to reach an oxygen saturation of 100%. Chest x-ray showed pneumomediastinum; small, bilateral pneumothoraces; and a small left lower lobe infiltrate. She was then started on vancomycin, gentamicin, Acyclovir, and ceftazidime, for possible pulmonary infection. Urinalysis and culture showed UTI caused by Pseudomonas. Over the next three days, the patient initially responded well with improved pneumothoraces and pneumomediastinum. Shortly thereafter she had increased respiratory distress and decreased O2 saturations requiring bag mask ventilation. Despite these measures, her O2 saturation remained in the 80s. As the patient was DNR and thus not to receive chest compressions or intubation, bag mask ventilation was stopped and the patient expired due to respiratory failure.
