Table of Contents
Washington University Experience | NEOPLASMS (GLIAL) | Ependymoma - Gross & Microscopic | 7A0 Case 7 History
Case 7 History ---- The patient was a 12 year old male with an ependymal tumor diagnosed at 3 1/2 years of age in 1985 with presenting symptoms of headache, emesis, and failure to thrive. At that time a diagnosis of ependymoblastoma was made and the patient underwent resection of the tumor of the posterior fossa with radiation therapy and placement of a VP shunt. The patient was in remission until presentation in 7/93 with headache, lethargy, and fever. A diagnosis of an anaplastic ependymoma recurrent which involved the right ventricle and extended into the brainstem. He underwent subtotal resection with radiation therapy followed by 7 courses of Cisplatin and VP-16, the last of which was in 3/94. His chemotherapy was complicated by recurrent episodes of acute renal failure. The chemotherapy was discontinued after renal toxicity became chronic with creatinine rising from 0.5 to 1.2. His other past medical history included recurrent upper respiratory infections with the most recent admission for bilateral lower lobe pneumonia in 12/94 which was treated with Vancomycin, Ceftazidime, and Erythromycin with good response, and the patient was discharged after two days of hospitalization. Other past medical history includes a history of a tracheostomy secondary to bulbar palsy and several G-tube placements secondary to poor PO intake. He also had a Nissen fundoplication performed secondary to chronic gastroesophageal reflux disease. His most recent MRI was in 5/94 which showed a mass posterior to the medulla and extending into the right foramen of Luschka, measuring 2.6 X 1.0 cm in maximum dimension. The MRI also revealed diffuse meningeal enhancement. The patient was admitted through the ER on 1/95 with a history of two hours of labored breathing at home followed by asystole and full arrest. EMS arrived and the patient was intubated. He received epinephrine by an ET tube and CPR. He arrived in the ER with a heart rate of 137 and a blood pressure of 60/28. At that point he was being mechanically ventilated. He was given IV epinephrine, bicarb drip, and several boluses of lactated ringer solution. His pupils remained fixed and dilated without response and blood pressures remained low. A DNR order was requested by the maternal grandmother who had legal guardianship, and the patient was admitted and extubated. At that point the patient experienced agonal breathing with a slowing ventilatory pattern leading to apnea and asystole.
