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Washington University Experience | NEOPLASMS (GLIAL) | Glioblastoma - Gross Pathology | 27A0 Case 27 History
Case 27 History ---- The patient was a 56-year-old female with a prior history of: hypertension, seizure disorder, motor vehicle accident approximately two years prior to admission with continued neck and back pain, s/p a C5-6 cervical fusion due to cervical spondylosis with radiculopathy in April, 2005. In September 2004 gradual progression of right-sided weakness of her upper extremity and dysarthria prompted a head CT which showed a diffuse abnormality that involved the white matter with extension into the corpus callosum and sparing of the cortex, causing mass-effect upon the ventricle, most suggestive of an infiltrative neoplasm. She was admitted with focal motor seizures of the right side of the body and was found to have a left hemispheric lesion. A CT scan in October 2005, showed minor increase of the midline shift. She apparently had been more confused and less alert over the recent past and then developed a severe headache and presented to the emergency room for evaluation in November 2005. While in the emergency room she became less responsive and was intubated for airway protection and management. She underwent a head CT which showed a 3 cm area of hemorrhage and then was taken to the angiography suite for angiogram to rule out an associated arteriovenous malformation. There was no evidence for vascular malformation or dural arteriovenous fistula seen. She then underwent an MRI of the brain, which showed a left temporal frontal hematoma centered in the region of the left middle cerebral artery bifurcation, new from 10/4/05. There was an infiltrative T2 abnormality in the left frontal and parietal lobe perhaps extending across the corpus callosum into the right hemisphere. There was considerable mass-effect in the left hemisphere with left-to-right shift of midline. A subsequent CT showed impending caudal herniation. The patient was taken to the OR on November 7, 2005 for decompressive hemicraniectomy, left anterior temporal lobectomy and hematoma evacuation. Her head CT showed post craniotomy changes of the left calvarium for evacuation of the left temporal lobe hematoma, some persistent hematoma in the frontal region, a small subdural hematoma underlying the craniotomy with persistent edema and mass effect. Her condition did not improve after the operation, and she developed bilateral extremity posturing. The decision was made to withdraw care and she died in early November 2005.
