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Washington University Experience | NEOPLASMS (MESENCHYMAL, NON-MENINGOTHELIAL) | Hemangioblastoma | 10A0 Case 10 History
Case 10 History ---- The patient was a 59 year old female who carried a clinical diagnosis of hemangioblastoma of the cerebellum. She was in relatively good health until 3 years prior to her death when she was admitted to an OSH with abdominal pain and depression. At that time she received 4 electroshock treatments and subsequent to that an LP was performed which was reportedly “abnormal”. Her workup showed a posterior fossa tumor with hydrocephalus and occipital craniotomy demonstrated a hemangioblastoma of the right cerebellar tonsil which was removed. The patient was readmitted to the OSH for shunt placement after which time she did relatively well except for difficulty with her memory. She was admitted to BJH two years prior to her death because of unsteady gait, syncope, clumsiness, memory loss, dim and blurred vision and lethargy. A CT head scan showed dilatation of the ventricular system. Her shunt was revised in and her gait improved but she was readmitted shortly thereafter approximately 1 year prior to her death because of continuing difficulty with vision and unsteady gait and depression. She was admitted for increasing difficulty with vision, incontinence of urine and stool, occasional numbness of the legs, increasing lethargy and depression. At that time she spontaneously improved but had a wide based unsteady gait with truncal ataxia and long tract signs. She presented again with a generalized tonic clonic seizure a few months prior to her death. CT scan showed some enhancement of the basilar meninges. In August of 1978 she began having increasing difficulty walking, hearing and with depression. A repeat CT scan showed small ventricles but marked enhancement of the meninges. Periterminally she presented with an increasingly unsteady gait, seizures, vasomotor changes and dementia. On exam she talked nonsense at times and didn't understand commands. Her gait was unsteady with no obvious paresis. She had vertical nystagmus and convergence nystagmus. There was mild right upper extremity weakness. CT scan showed enhancement of the basilar meninges especially around the 3rd ventricle. She was thought to have a chronic inflammatory process or meningeal carcinoma but a brain biopsy (parasagittal cortex) only showed astrocytosis. Her hematocrit was 60%, she was phlebotomized and her brain radiated. Her mental status gradually deteriorated and she was sent to a nursing home where she developed a fever due to a urinary tract infection. She was treated with antibiotics but developed a cardiorespiratory arrest the following day and expired.
