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Washington University Experience | VASCULAR | Cavernous Angioma | 5A0 Case 5 History
Case 5 History ---- The patient was a 34 year old female with a past history of rheumatoid arthritis and possible mitral valve prolapse. She was first admitted to BJH in February 1979 with a history of temporal lobe seizures. Approximately l.5 years prior to that admission she noted a spell consisting of a sensation of tightness in her stomach associated with a sour nauseating smell and taste unlike anything she had ever experienced before. These spells lasted approximately 2 minutes and at first occurred approximately once a week which gradually increased in frequency to about 3-6 per day. She also began to have a tingling sensation in the epigastrium, urinary incontinence, and memory lapses during these periods. EEG revealed focal slowing in the right mid-temporal area. CT scan demonstrated a contrast enhancing lesion at the top of the right temporal lobe which proved to be a glioblastoma. She received 5040 rads to the head and was selected for treatment with high dose BCNU and autologous bone marrow rescue. She continued to have seizures although at a reduced frequency on Dilantin. A repeat CT scan in May 1979 showed decreased density of the right temporal lobe which enhanced with contrast thought consistent with radiation effect. In February 1980 the patient returned to Barnes Hospital for a course of BCNU and bone marrow transplant. She was readmitted with a two week history of rapidly progressive cough and shortness of breath, and diffuse alveolar infiltrates on the chest X-ray. Open lung biopsy showed bronchiolitis obliterans. No infectious process could be documented on multiple smears and cultures. Postoperatively a trial of high dose steroids was initiated. Her course was complicated by difficulties with oxygenation and ventilation, persistent hypotension, decreasing cardiac output and rapidly deteriorating liver function. Terminally the patient developed an upper GI bleed associated with a drop in platelets and prolonged clotting times resulting in hypotension and bradycardia and expired.
