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Washington University Experience | NEOPLASMS (GLIAL) | Diffuse midline glioma, H3 K27-altered | 8A0 Case 8 History
Case 8 History ---- The patient was a 14 year old male admitted to SLCH in April 1975 for evaluation of a left hemiparesis. Approximately 1 week prior to admission the patient noted transient weakness of his left arm and leg, with persistent difficulty in using his left hand. Neurological examination was remarkable in the findings of a mild left hemiparesis and left cerebellar signs. A mild left hyperreflexia was noted and an equivocal left Babinski sign was present. Superficial reflexes were absent. Symptomatic diplopia was present on left up gaze. Corneal reflexes were present bilaterally. A mild left central facial weakness was noted and his tongue deviated prominently to the left on protrusion. Cranial nerves were otherwise intact. He subsequently noted some improvement as an outpatient, but returned to the hospital later in April 1975 with an increased left hemiparesis. A right third ophthalmoplegia was described by Ophthalmology and the clinical possibilities enlarged to include possible basilar encephalitis. His third admission was June 1975 because of worsening of his left hemiparesis. Significant neurologic findings included a left central facial weakness and protrusion of his tongue to the left. A left hemiparesis with increased tone was noted. Reflexes were described as brisk throughout and bilateral extensor plantar response was present. Sensory examination was normal. encephalography was performed which revealed a mass in the midbrain, posteriorly displacing and bowing the aqueduct. These findings were most compatible with a midbrain tumor and radiation was then begun. A dose of 5600 rads in 6 weeks was then delivered. Outpatient chemotherapy was conducted with methyl-CCNU and procarbazine. His fourth admission was in January 1976, at which time his left hemiparesis was again noted, and he had a corneal ulceration which was treated symptomatically. Increased vomiting had been present prior to admission and this was felt due to direct medullary involvement rather than hydrocephalus. He was discharged with symptomatic treatment. At home, he apparently gradually deteriorated with progressive involvement of lower brain stem cranial nerves. Aspiration, pneumonia and dysphagia were noted. He apparently began having irregular respirations and quietly died in March 1976.
