Left frontal/temporal GBM

Case #94: MRI Brain,12/30/92: Left frontal Glioblastoma Multiforme.

CC: Headache

Hx: This 69y/oRHF presented with a 3 week history of progressively worsening headaches, nausea, vomiting and light headedness. She developed slurred speech and an expressive type aphasia 5 days prior to presentation. She was examined locally on 12/30/02 and following a brain CT scan was given Decadron 10mg IV and Dilantin 750mg IV; and transferred to UIHC for evaluation.

MEDS: Synthroid, ASA 650mg qd.

PMH: 1)hypothyroidism secondary to Hashimoto's thyroiditis. 2)celiac sprue.

SHx: Family denies any history of tobacco, ETOH, or illicit drugs in the past.

FHx: unremarkable.

EXAM: BP133/65 HR81 RR16 37.3C

MS: Alert and oriented to name. Dysarthric speech and difficulty with naming, comprehension and repetition. Multiple paraphasic errors (of unspecified type) were noted by neurosurgery.

CN: Pupils 3/3 decreasing to 2/2. EOM intact. Corneas intact bilaterally. Right lower facial weakness. +/+gag reflex. Tongue midline.

Motor: mild right hemiparesis (arm=leg). normal muscle tone.

Sensory: patient unable to cooperate with exam.

Station: mild to no pronator drift on right.

Gait: Not assessed.

Reflexes: 3/3 throughout. Plantars were flexor bilaterally.

Gen exam: unremarkable.

Course: Outside HCT with contrast, 12/20/92, revealed a large enhancing left frontal mass with surrounding edema. The patient was placed Decadron 20mg IV q6hours x 24 hours; then 10mg IV q6hours. MRI brain/brainstem on 12/30/92 revealed a 3x3x2.5cm mixed signal mass in the left frontal lobe with marked surrounding edema. There appeared to be early and late subacute hemorrhage within and surrounding the mass. Post-gadolinium images showed enhancement of the periphery of the mass with a second ring enhancing lesion present anterior to the first lesion. The patient underwent left frontotemporal craniotomy and tumor debulking on 1/2/93. Tissue pathology was consistent with glioblastoma multiforme. Post operative HCT with contrast revealed residual enhancing tumor. She therefore underwent stereotaxic placement of after loading catheters for iodine- 125 brachytherapy on 1/19/93. The catheters were removed 1/27/93. She was then treated with 6020cGy (total) conventional external beam radiation and maintained on Decadron during this 6 week period. She was then treated with BCNU chemotherapy in 3/93. She was last seen at UIHC on 5/11/93.