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Washington University Experience | NEOPLASMS (HEMATOLYMPHOID) | Lymphoma, primary | 7A0 Case 7 History
Case 7 History ---- The patient is a 68-year-old man who began acutely experiencing headaches, dizziness, and nausea. The headaches were severe, constant, and throughout his head. He was evaluated at an OSH in August 2006 and diagnosed with dehydration and discharged home. Two days after discharge, the patient began feeling extremely dizzy and weak, and fell to the ground. He experienced no loss of consciousness or head injury. He stated that he felt such generalized weakness that he could not continue to stand up. After the fall, the patient presented to an outside hospital emergency room. MRI of the brain revealed a 3 cm x 3 cm right cerebellar lesion extending to the corpus callosum and right parietal lobe, which exerted moderate mass effect on the fourth ventricle, causing approximately 70% narrowing. CT of the chest/abdomen/pelvis found no evidence of malignancy. The patient was transferred to BJH for further care. MRI there showed two uniformly enhancing lesions; one in the splenium of the corpus callosum, the other in the right cerebellar hemisphere. Whole body PET scan suggested no evidence of metastatic disease and increased FDG uptake only in those lesions identified by the brain MRI study. He was transferred to the neurosurgery service, received steroids, and underwent a partial resection of the cerebellar lesion on 8/11. Clinical diagnosis: Multifocal glioblastoma multiforme versus lymphoma versus metastatic disease. Operative procedure: Right occipital craniotomy for tumor.
