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Washington University Experience | NEOPLASMS (GLIAL) | Gliomatosis cerebri | 6A0 Case 6 History
Case 6 History (AANP DSS 2000-5) ---- In 1995, this 82-year-old man first noticed gait disability with several falls. His past medical history included in situ carcinoma of the bladder and aortic valvular disease. His abnormal gait was attributed to Parkinsonism but a treatment trial with carbidopa/L-dopa was not successful. An OSH MRI study of his head was interpreted as showing a "pontine glioma", and radiation therapy followed but MRI images were re-interpreted elsewhere with no diagnosis of tumor. In 1997, he was evaluated in Albany, N.Y., and his findings were thought compatible with progressive supranuclear palsy. In 1998, an extensive new examination by a consulting neurologist revealed multiple system atrophy. Low-dose pergolide was begun. Additional MRIs were obtained. They were interpreted as normal. He made three follow-up visits before he died. They all indicated further deterioration of his Parkinsonism but also produced evidence for some dysautonomia, including incontinence. His neurological disability required admission to a nursing home. Urinary retention and herpes zoster prompted hospital admission, and a diagnosis of carcinoma of the prostate was made. His prostate-specific antigen rose to 92, and a bone scan showed innumerable metastases. Comfort measures were taken, and he died 4 years after the onset of his neurologic disability. The general autopsy revealed adenocarcinoma of the prostate with metastatic spread, cardiomegaly and atherosclerosis. ---- At autopsy, the unfixed brain weight was 1130g with hydrocephalus. Only a single section was provided at the AANP diagnostic slide session but the presenters described the lesion as quite widespread, involving the molecular layer and white matter of the cerebellum and also the CA 1 region of the hippocampus.
