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Washington University Experience | NEOPLASMS (METASTASES) | Single Case | 1A0 Case 1 History
Case 1 History ---- The patient was a 72 year old female admitted with known adenocarcinoma of the lung. She did well until September 1979, when she developed a mild right-sided hemiparesis and dysarthria. A month later she was found sitting in a chair with rhythmic jerking movement of her right arm and leg. On admission to BJH she again had only mild right hemiparesis. Admission chest Xray revealed a 4 cm density in the right upper lobe and right paratracheal fullness. Sputum cytologies were subsequently positive for adenocarcinoma. The initial head CT scan revealed an extensive area of decreased density in the left hemisphere which was felt to be an infarct of the left middle cerebral artery. A repeat CT 10 days later showed the same area of decreased density with mass effect at the left frontal horn and mixed density within the region, thought to be a metastasis with surrounding edema. Metastatic work-up revealed multiple areas of metastasis, including the right occipital bone, several ribs, a thoracic vertebral body and right femur. She was treated with Dilantin and Decadron and was discharged after 15 days of hospitalization. Approximately 1 week after discharge the patient's mental status began to slowly decrease. She was then begun on a treatment of radiation therapy to the head. She however received only 600 rads before voluntarily discontinuing the radiation. She again developed focal seizures which were controlled with Dilantin and Phenobarbital. The patient continued to do poorly, however, and she was readmitted because of poor oral intake In November 1979. With rehydration the patient's mental status improved. However, her hematocrit decreased from 40 to 30 in the first week with guaiac positive stools. The patient responded to antacids and Cimetidine. By the time of discharge 2 weeks after admission the patient was back to her previous baseline. The patient was again admitted at the end of December 1979 because of poor oral intake, coffee ground vomitus and melanotic stool. Chest Xray revealed the right hilar mass had markedly increased in size. She was transfused and rehydrated. Her mental status again returned to her previous baseline with this therapy. One week after admission in early January 1980 the patient developed focal seizures of the right side of the face and head CT revealed left sided occipital edema. After the most recent seizure the patient remained lethargic. The remainder of her hospital course was one of a slow decline culminating in her death which occurred in early January 1980.
