Table of Contents
Washington University Experience | NEOPLASMS (HEMATOLYMPHOID) | Lymphoma, Intravascular | 17A0 Case 17 History
Case 17 History ---- The decedent was a 64-year-old male with a history of prostate cancer status post prostatectomy and hormonal/radiation therapy in 2019, hypertension, and coronary artery disease who initially presented to BJH on 7/23 with intermittent episodes of left facial droop and headaches which initially started 2 months previously. Upon arrival, he reported resolution of his symptoms; however, initial head CT on 7/23 showed small areas of intra-parenchymal hemorrhage within the right occipital lobe with surrounding vasogenic edema which were new when compared with prior imaging dated 6/20 and the patient was subsequently admitted for further evaluation. Follow-up MRI performed on 7/24 showed involvement of the bilateral cerebellar hemispheres and bilateral parietal/occipital lobes with associated leptomeningeal enhancement concerning for vasculitis. The decedent then underwent angiography on 7/25 and following the procedure, was noted to be obtunded. He then underwent CT angiogram of the head which showed new areas of possible hemorrhage with a defect within the right posterior inferior cerebellar artery concerning for dissection versus thrombus. The decedent was then intubated and transferred to the neurologic intensive care unit for further management. He initially began to improve clinically; however repeat MRI on 7/26 showed progression of the intraparenchymal hemorrhage with new subarachnoid hemorrhage and multiple punctate infarcts within the right cerebellum, pons, right caudate nucleus, and frontoparietal areas. On 7/28 the decedent underwent open brain biopsy for further evaluation of possible vasculitis where increased intracranial pressure was noted. Following the procedure, neurologic findings of dilation of bilateral pupils were noted and repeat CT showed diffuse cerebral edema with findings concerning for herniation. On 7/29 the decision was made to not pursue further intervention and the patient passed away.
