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Washington University Experience | NEOPLASMS (GLIAL) | Diffuse midline glioma, H3 K27-altered | 10A0 Case 10 History
Case 10 History ---- The patient was a 15 year old male whose neurologic and medical history dates from 7/92. At that time, the patient presented with headaches, recurrent emesis, and a ten pound weight loss. CT scan revealed marked hydrocephalus with an enhancing mass lesion in the suprasellar region, confirmed by an MRI scan. CT directed stereotactic biopsy at an OSH revealed a low grade astrocytoma. The patient was referred to SLCH in 8/92, for resection and further treatment. The patient underwent supra-cerebellar, infratentorial resection in 11/1992. Approximately three weeks after surgery, chemotherapy with vincristine and craniospinal radiation were begun. The patient was readmitted to SLCH in 6/1993 with complaints of diplopia, sleepiness, and ataxia. An MRI scan revealed a gadolinium-enhancing lesions of the left medial-posterior thalamus, left superior colliculus, and left middle cerebellar peduncle. He was discharged with a probable diagnosis of radiation necrosis. His chemotherapeutic regime was intensified. Shortly after discharge, the patient's sleepiness returned. Again, his chemotherapeutic regime was intensified. In early 11/93, the patient developed acute hydrocephalus, necessitating ventriculoperitoneal shunt placement. Postoperatively, his mental status continued to be poor. He slept 20 hours per day. He was discharged to his home with "do not resuscitate" orders on mid-November 1993 and died shortly thereafter.
