7 years old, male.
Diagnosis: DIFFUSE INTRA-AXIAL EXPANSIVE LESION OF THE ENCEPHALIC TRUNK NOT SURGICALLY INVESTIGATED.
First-born child, he has a younger brother of 5 years old who enjoys a good health. Right-handed child. Not findings of allergies to drugs and food intolerances.
Normal spontaneous delivery. Breastfeeding until six months of age. Psychophysical development within norm limits. He got the vaccinations according to law.
Among the exanthematic diseases: sixth disease when he was 1 and a half year; varicella when he was 5.
No surgical operation in the past and no current home therapy.
The clinical symptoms began about one and a half month ago with general asthenia, right hand tremors, state of anxiety and episodes of diffuse headache of short duration, with a frequency of about twice a day with spontaneous remission.
Therefore, he carried out a paediatric visit with evidence of a right asymmetry of the mouth. From 10/2008 repeated vomit episodes occurred, associated with slowing down of the ideomotor functions. On 11/2008 the child was, therefore, brought to the emergency room of the Trento Hospital, where a neurological examination was carried out with finding of a right hand side mouth deviation, uncertain walking, tendency to break up and difficulty in the word articulating activity. A brain CT scan was then performed, with evidence of an expansive lesion on the encephalic trunk that had a swollen appearance. A brain magnetic resonance (MRI) with contrast was then performed, as a further in-depth analysis whose medical report is integrally carried:
“Examination performed as a complement of today’s CAT scan without contrast medium.
We confirm the presence of an expansive lesion of the encephalic trunk, widely infiltrating the pons, the mesencephalon (especially at the right slope), the right cerebellar peduncle, and with an anterior esophitic development with the tendency to wrap the basic artery towards the front.
This formation is characterized by a hyper-intensity in the T2 weighted images, and a hypo-intensity in the T1 weighted images, with nearly absent contrastographic impregnation after Gadolinium (6 ml I.V.) administration: the finding lets hypothesize for a glioma of the encephalic trunk. Nodular enhancement foci are present at clivus level, especially at the right hand side of the median line, likely to be a leptomeningeal dissemination.
Light hyper-intensity of the white peri-ventricular substance close to the frontal and occipital horns in the FLAIR sequence due to an initial subependymal liquor overflow, sign of obstructive hydrocephalus.”
The young patient was, therefore, sent to the Hospital Istituti Ospitalieri of Verona for action.
During this hospitalization it was attempted to carry out a high-field MR imaging (3T), diffusion and spectroscopy, but the child didn’t cooperate for the required time and the procedure was suspended; the neuroradiologists have confirmed what already expressed in the medical report by the colleagues of the Santa Chiara Hospital of Trento, the lesion is, in all probability, a glioma b.g.
For its characteristics of diffuse inherent lesion it is not susceptible of surgery treatment. His parents have consulted a second doctor who has confirmed what it had already been expressed by the colleagues of Trento.
The steroid therapy (Decadron 2 mg x 2 I.V.) has brought about an improvement in the clinical situation at admission.
He was discharged from Verona Hospital on 11/2008 and continued home the current intravenous steroid therapy. Afterwards, on 11/2008, further hospitalization at the National Cancer Institute of Milan, where he is still hospitalized.
With regard to the diagnosed therapy the following elements are reported:
- As for the therapy prescribed to the patient: since 11/08 (date of hospitalization at the Borgo Trento Hospital of Verona, where he remained for three days) the therapy consists of:
Soldesam 0.2% (32 drops in the morning and 16 drops in the afternoon)
Nexium (1 tablet of 20 mg)
- Afterwards, he was moved to the National Cancer Institute of Milan, since 11/08 to the aforesaid drugs the antibody NIMOTUZUMAB (once a week for 12 consecutive times) was added.
The second dosage of NIMOTUZUMAB will be administered on 11/08.