Table of Contents
Washington University Experience | NEOPLASMS (MENINGIOMA) | Transitional | 2A0 Case 2 History
Case 2 History ---- The patient was a 78 year old female with a history of multiple meningiomas and a sketchy history of Alzheimer's disease and was admitted to BH on 11/21 after she fell and broke her left hip. A neurological exam at that time revealed the patient to be sleepy but arousable to stimulation, oriented to person, able to follow commands occasionally, having extra-ocular motions intact, unable to protrude her tongue, and upgoing right and downgoing left toes. A head CT showed a right sphenoid wing meningioma and an olfactory groove meningioma. Additionally, the ventricles appeared to be mild to moderately enlarged. The differential diagnosis for her decrease in mental status was listed as systemic, due to a decrease in oxygenation, medications, uremia, trauma, ischemia, seizures, and psychosis. On 11/22 the patient went to the OR where she underwent a left hip open reduction and internal fixation without complications. On 11/26 the patient was diagnosed with small bowel obstruction. Surgeons performed a celiotomy, lysis of adhesions, and a small bowel resection with primary anastomosis. The patient did well until 12/2 when she complained of increasing abdominal distension and was diagnosed with ileus. Blood cultures and wound cultures grew out a Gram negative bacillus that was a combination of Enterobacter and Klebsiella. Urine cultures grew out Citrobacter and Candida. A tracheal culture grew out Staphylococcus. The patient was treated with broad spectrum antibiotics. There was evidence of bowel contents in the abdomen. On 12/13 she started to desaturate and present with renal failure and an ARDS picture. It was decided to withdraw pressor support and antibiotics and the patient expired that day