Friday, October 16, 2009

Brain Metastasis of Testicular Yolk Sac Tumour

28 Years old Male
Diagnosed Left testicular tumour with lungs metastasis 1 year ago
Underwent left orchidectomy and HPE diagnosis of Yolk sac Tumour
He had completed radiotherapy and chemotherapy
Presented with 1/12 history of progresive left sided body weakness and numbness
Associated with worsening headache
Admitted with 1 episode of generalised tonic clonic seizure
O/E Pink, alert
GCS full
BP 120/71
PR 77
Higher mental function intact
No cranial nerves deficit noted
Left hemiparesis 3/5 with sensory impairment

CT scan brain (plain + contrast) done showing homogenous enchanced tomour over right post central gyrus with marked surrounding edema

MRI was performed and he was planned for surgery

He underwent right parietal craniotomy and tumour excision. The tumour was just below a thin grey matter of post central gyrus (detected using intra-operative ultrasound). Post-central gyrus corticotomy done.
The tumour was pink-greyish in colour, soft to firm in consistency, well-circumscribed with surrounding gliotic brain tissue, highly vascular- completely excised

Post-operatively he was extubated and maintained on dexamethasone.
Clinically he still having left hemiparesis power of 3/5

CT scan (plain) post-operative day 1 showing pneumocranium with edema, no post-operative bleeding.

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