4/26/2005 Case 1: LG glioma with prominent antioblastomatous component

Clinical History:

Chief complaint:
Headache, Gait disturbance and falls

History of present illness:
The patient is a 61-year-old bus driver with untreated hypertension and hypercholesterolemia. Since November of 2004 he has been experiencing burning pain in the back of the head following non-localized headaches. The burning sensation typically lasts a few minutes and is relieved with Excedrin®. His primary care physician suspected a stroke and prescribed antihypertensive medication and cholesterol lowering agents, which the patient discontinued. Since December of 2004 the patient has also been complaining of gait changes, namely' festinating gait'. The patient remembers five to six falls In January of 2005, but is able to walk unassisted and continues to drive his bus.
The patient has lost five Ibs since the onset of symptoms, but denies night sweats, fevers or chills. He does not complain of visual, cognitive or personality changes. Also, he declines cardiac, pulmonary, or renal disease.
He went to the emergency room of an outside institution, where a magnetic resonance imaging study was performed. It revealed a mass in the vermis cerebelli. The patient was transferred to CUMC for further management.

Physical examination:
The patient's systemic exam was unremarkable. The neurological evaluation was remarkable for moderate bilateral dysmetria and gait disturbances.

Operative impression:
The mass was seen along the superior medial portion of the cerebellum in the inter-hemispheric fissure. The tumor was well demarcated from the adjacent parenchyma. It was sharply dissected along its pia arachnoid and then removed en bloc.

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