5/8/2012 Case 3

Presented by: Dr. Chandrakant Rao and Dr. Jennie Zeng - King’s County Hospital Center

Clinical History:

The patient is a 29-year-old man with past medical history of diabetes mellitus, hypertension and brain neoplasm of the left frontal lobe.  He first had a seizure around the age of 13.  A left frontal lobe lesion consistent with a low grade glioma was discovered, and he was placed on anti-epileptics.  The plan at the time was to monitor the mass with serial MRI’s. Medical records indicated that he had MRI’s done at King’s County Hospital Center (KCHC) in 2002 and 2004 that did not reveal significant interval change.  From 2004 to 2011 no MRI’s were done at KCHC.  As per his mother, his seizures were generally under control over the years; but he had another seizure in 2010 which led to an MRI that revealed disease progression.  Complaints of memory loss were noted after this seizure.  He underwent an MRI at KCHC in 2011 which revealed significant progression of disease since 2004, with involvement of the basal ganglia, the thalamus and the temporal lobe, measuring 6.2 x 4.8 cm, with reported extension of abnormal signal into the contralateral basal ganglia and thalamus.  The MRI in 2011 was read as being compatible with Grade III astrocytoma.  The patient underwent a brain biopsy on 11/15/2011 at KCHC.  After biopsy and before admission on 1/18/2012 he had acute mental status change that might have been due to severe hyperglycemia and uncontrolled diabetes mellitus.  His memory was getting worse, and he did not recognize members of his family.  On 3/3/2012 he underwent a left fronto-temporal craniotomy for resection of tumor.