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Washington University Experience | NEOPLASMS (MENINGIOMA) | Gross Pathology | 13A0 Case 13 History
Case 13 History ---- The patient was an 11 year old male who developed recurrent headaches, frequent emesis and social withdrawal. A year later (1976) he began having grand mal seizures which were poorly controlled. In early 1977, he weighed 14kg (< 5th%) and, on SLCH admission had a dilated left pupil, left ptosis, blurred optic disks, ankle clonus, and abnormal resistance to passive flexion of the neck. A CT scan showed enlargement of the lateral and third ventricles with patchy meningeal enhancement following contrast. A right frontal brain and meningeal biopsy were non-diagnostic. In 1981, increasing ventricular size and more prominent contrast enhancement along the floor of the middle fossa prompted additional workup. His optic disks were blurred with engorged retinal veins. There was a Kemig sign and a left third nerve palsy. He showed a facial diplegia with greater weakness on the left than the right. There were fasciculations in the proximal muscles of his arms and legs with increased tone in the legs. Reflexes were diffusely hyperactive; both toes were upgoing. A biopsy was taken from the floor of the left middle fossa showing a meningioma. Following surgery, the patient remained responsive for approximately 10 days at which time he lapsed into a coma. Five days later he had a ventriculo-atrial shunt placed. Post operatively, the patient's mental status did not improve. He expired 9 days later secondary to respiratory difficulties.
