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Washington University Experience | NEOPLASMS (GLIAL) | Diffuse midline glioma, H3 K27-altered | 3A0 Case 3 History
Case 3 History ---- The patient was a 9 year old female who was diagnosed with high grade astrocytoma of the left thalamus in 10/2014. In 02/2015 she experienced an acute change in mental status. CT showed significant cerebral edema, midline shift, and concern for herniation; subsequent MRI identified hemorrhage within the tumor, and partial herniation. She was stabilized in the ICU and transferred to the floor with plans for hospice care. During her stay she was noted to have less responsiveness to treatments and worsening respiration with increased efforts. Another CT study showed further midline shift and unilateral uncal herniation. After discussion with the family, she was placed on DNR/DNI status, and therapy was minimized; pain was controlled with morphine and Ativan. She developed a much slower and quieter breathing pattern than earlier that morning and died.
