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Washington University Experience | NEOPLASMS (MESENCHYMAL, NON-MENINGOTHELIAL) | Hemangioblastoma | 5A0 Case 10 History
Case 5 History ---- The patient was a 53 year old male with a history of syringomyelia, syringobulbia, Buerger's disease, hypertension, adult diabetes mellitus and hyperthyroidism S/P thyroid ablation who presented to BJH on October 10 with 48 hours of decreased mental status, cyanosis, and a complaint of "it hurts all over my body". He had initially presented on September 2 with a three year history of progressive left-sided numbness which began with leg numbness and progressed to the trunk and left arm. He also developed impotence, urinary and fecal incontinence, and dysphasia. A CT myelogram showed widening of the spinal cord with syringomyelia involving the cervical, thoracic, and lumbar cord as well as syringobulbia. He underwent a syringo-subarachnoid shunt on September 8. He showed progressive improvement with speech and swallowing and was discharged home on September 15. On September 20 he returned to the emergency room with progressive weakness, speech and swallowing difficulties. He had E coli bacteremia and was treated with antibiotics. He was oriented only to name and did not follow commands. His cranial nerves were intact. Deep tendon reflexes were 2+ and equal bilaterally with plantar responses flexor bilaterally. Evaluation on admission was remarkable for an arterial blood gas with a pH of 7.44, PC02 31, P02 62, and HC03 22 on 40% oxygen. A chest X-ray was normal and a VQ scan showed a high probability for pulmonary embolus. A lower extremity venous Doppler exam showed deep venous thrombosis in the left common femoral, superficial femoral, and popliteal veins. Head CT showed postoperative changes from the occipital craniotomy and shunt placement with no acute problems. On October 12 he had an episode of decompensation thought to be secondary to another pulmonary embolus. A filter was placed in the inferior vena cava on October 12. On October 13 he was found apneic and pulseless with a narrow complex bradycardia. Resuscitative efforts were not successful.
