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Washington University Experience | VASCULAR | Infarct - Embolic | 5A0 Case 5 History
Case 5 History ---- The patient was a 27 year old man who one year prior to his final admission had pelvic disarticulation of the right femoral head because of chondrosarcoma. This was done at the Mayo Clinic and after the surgery the patient received 3 courses of chemotherapy, first with Bleomycin, Adriamycin, and Cis-platinum, secondly with Bleomycin and Vincristine, and at the time of admission was in the process of being treated at BJH with BCNU. In June of 1981 the patient was found to have pulmonary metastases. On the day of BJH admission the patient had a rather sudden onset in the morning of a left hemiparesis, agitation and confusion. He had significant decreased acuity and vasculature in the right eye. There was left facial weakness. On admission a CT scan was read as normal. Chest x-ray showed multiple bilateral pulmonary nodules. An LP showed a few inflammatory cells. Later that same night the patient was begun on Heparin and he was seen by ophthalmology. They confirmed a right Marcus Gunn pupil and established central retinal artery and choroidal artery occlusions. On the day after admission, the patient complained of a severe right-sided throbbing headache. On 10/14 his platelet count had dropped to 96K. The next day he had three generalized seizures and became unresponsive with flaccid left hemiparesis. A repeat CT on 10/15 showed generalized swelling and a probable right posterior frontal lobe cerebral infarct. The patient was begun on Decadron and from that time the patient received supportive care. He expired on 10/19. ---- Autopsy showed metastatic chondrosarcoma to the lung with gross invasion of pulmonary veins. Multiple areas of the brain, the eye, the right kidney, and the spleen were involved by infarcts with vasculature occluded by tumor emboli. Infarcts in the cerebral hemispheres vary in their evolution from subacute forms to very acute lesions with all degrees of evolution in between.
