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Washington University Experience | VASCULAR | Edema - Cerebral | 5A0 Case 5 History
Case 5 History ---- This 52 year old man was admitted for evaluation of left hemiparesis and change in personality. In the month prior to admission he had difficulty with recent memory, seemed depressed and had lost interest in everything. For the past one to two weeks, he had facial asymmetry and after walking for a while he started to drag his left leg. The patient was oriented and followed commands but no detailed mental status examination was performed. Mild left hemiparesis involving face, arm, and leg was present. The following morning the patient was found unresponsive on the floor in the bathroom. He postured to sternal rub or direct pain in all extremities. Pupils were initially 2 over 2, round and reactive to light but soon became 5 mm right, 3 mm left and nonreactive to light. Extraocular movements were intact laterally to Doll's eyes maneuver. Plantar reflexes were bilaterally extensor. He was treated with Decadron, hyperventilation, and Mannitol and transferred to the NICU with no improvement. A CT scan showed a hemorrhagic lesion in the right frontal area with surrounding edema and a right to left shift. Due to the grim prognosis, only supportive care was offered from that time and he was found cyanotic without respirations and pronounced dead. ---- Autopsy showed glioblastoma involving the right corpus striatum and thalamus with recent superimposed massive hemorrhage, Duret brainstem compression hemorrhages and left uncal petechial hemorrhages consistent with uncal herniation. Brain weight was 1530 grams.
