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Washington University Experience | NEOPLASMS (GLIAL) | Gliomatosis cerebri | 4A0 Case 4 History
Case 4 History ---- The patient was a 56-year-old woman with a prior history of: hypertension, seizure disorder, motor vehicle accident (2 years prior) s/p a surgical C5-6 cervical fusion due to spondylosis with radiculopathy. She was thought to have had a cerebral vascular accident in September 2004 when she presented with gradual progression of right-sided weakness of her upper extremity and dysarthria. A head CT done at that time showed edema within the left hemisphere with a diffuse abnormality that involved the white matter with extension into the corpus callosum and relatively sparing of the cortex, causing mass-effect upon the ventricle, most suggestive of an infiltrative neoplasm. Right focal motor seizures accompanied a left hemispheric lesion. She was treated with Dilantin and Decadron. 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 leading to presentation to the ER for evaluation in November 2005. While in the emergency room she became less responsive and was intubated for airway protection and management. A head CT showed a 3 cm area of hemorrhage but no vascular malformation. Brain MRI showed a left temporal frontal hematoma centered in the region of the left middle cerebral artery bifurcation as well as an infiltrative T2 abnormality in the left frontal and parietal lobe extending across the corpus callosum into the right hemisphere; considerable mass-effect in the left hemisphere with shift of midline from left-to-right .A subsequent CT showed impending caudal herniation. The patient was taken to the OR on November, 2005 for decompressive hemicraniectomy, left anterior temporal lobectomy, hematoma evacuation and biopsy. Her condition did not improve after the operation and she developed bilateral extremity posturing and died.
