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Washington University Experience | VASCULAR | Edema - Cerebral | 1A0 Case 1 History
Case 1 History ---- The patient was a 33 year old woman with carcinosarcoma of the breast diagnosed by biopsy in December 1976 treated with modified radical mastectomy. Pulmonary metastases were treated with chemotherapy with Adriamycin, Cytoxan and methotrexate in June 1977, with three courses administered when her clinical condition began to deteriorate with increasing chest pain, left pleural effusion and development of a hilar mass. At the end of August chemotherapy was felt to have been unsuccessful and radiation therapy was begun the week before her final admission for chest pain, dyspnea and weakness. An attempt was made to sclerose the left pleural space. The next day she became drowsy without focal neurologic signs. In mid-October decreased consciousness supervened with fixed pupils and abnormal calorics, soon culminating in right decerebration and left decortication. Treatment with Decadron was instituted. EMI (an early form of CT) revealed multiple large contrast enhancing lesions in the cerebral hemispheres with edema and right to left shift. Further decompensation resulted in death on the fifth hospital day. ---- Autopsy revealed unfixed brain weight of 1300 grams with multiple cerebral metastases and resultant local edema. A large single 3 x 3 x 3 cm metastasis in the right occipital pole had become hemorrhagic with necrosis of bordering occipital cortex, and may well have upset the precarious pressure relationships within the skull resulting in uncal and cerebellar tonsillar herniation and death.
