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Washington University Experience | NEOPLASMS (GLIAL) | Diffuse midline glioma, H3 K27-altered | 13A0 Case 13 History
Case 13 History ---- This patient was a 9 year old female who first came to medical attention in December 1974. At that time she was complaining of a left esotropia. She was referred to an eye surgeon and it was suggested that the eye be patched at that time. In June. 1975, a right esotropia developed and the patient was referred to a neurologist. Neurological evaluation at that time showed only bilateral-lateral rectus palsies, left greater than the right. An EMI (old CT) performed at an OSH showed a brainstem lesion which was supported by an angiogram and ventriculogram. The patient was referred for radiation therapy of a probable glioma in the region of the brainstem. At the time of the first radiologic consultation neurologic examination showed that she was unable to deviate her eyes laterally to either side. She underwent a course of radiation therapy of 5350 rads and there was improvement in her eye signs to the point where her only residual was some nystagmus on right lateral gaze. In May 1976, she began to manifest behavior changes with intermittent headaches and a repeat EMI scan showed recurrence of the tumor. At that time, she was placed on a protocol of BCNU, Vincristine, Procarbazine and Dexamethasone. She showed a variable response and was placed back on Dexamethasone and Demerol treatment for her severe headaches. She had a variable response over many months to that therapy. At the end of the chemotherapy she had anemia secondary to the chemotherapy with a Hgb of 7.3 and WBC of 2200. At an outpatient visit, worsening papilledema was noted, ataxia was worse and she demonstrated bilateral Babinski signs. On 5May 2 Dilantin was started due to another episode of seizures. The patient began having problems swallowing but had not had any recent headaches, emesis or seizures for approximately 3 days. The last note in the chart reports that the patient died later in May 1977.
