Carcinomatosis Meníngea secundaria A Tumor primario del Sistema Nervioso Central (Snc)

Abstract

Analysis of the clinical case of a female patient of 23 years with a history of brain tumor and incomplete removal thereof (Lymphoma Diffuse small and medium B cells) approximately 1 month and a half ago, appendectomy about 15 days ago. Who goes for about 8 days ago presents headache of moderate intensity, compression type, and abdominal pain holocraneana intensive, crampy, diffuse, accompanied by nausea, vomiting arriving on several occasions, asthenia and myalgia. The T / A 90/60 mmHg physical examination, FC 80 lpm, FR 20 rpm, T ° 37.7, awake, álgica, feverish, pale-oriented; Head scar + - 15 cm length in right frontotemporal region, ptosis left, mydriatic pupils + - 7 mm, anicteric sclera, pale conjunctive; neck, painful on palpation and movement in posterior region, marked rigidity, Brudzinski sign (+); soft, depressible painful mesogastrio, ureteral point and rights + middle and lower abdomen, slightly decreased RHA. Upper and lower members have pain on movement and tenderness, decreased tone, strength 4/5 not present edemas pulses, capillary refill <2 sec. neurological exam-oriented patient, Glasgow 15/15; higher mental functions preserved. Cranial nerve: N. Optical (II), alteration of bilateral visual acuity: oculomotor (III) Motor, left ptosis, bilateral mydriasis; Pathetic and Abducens (VI) preserved. Exam Engine: patient who remains in the supine position, can not assess progress. preserved superficial and deep sensitivity. Complementary tests: Leukocyte 8.61 x 103, 80.2% segmented, Mon 3.1, Lyn 16.3, Eos 0.3, 6.6 Urea, BUN 3 63 Glucose, Creatinine 0.69, PCR 69.3; CSF study: xanthochromic, slightly cloudy, 0xmm3 cells, glucose 1.0, 2908.1 proteins, LDH 283u / l, negative for malignancy cytology; Eco Abdominal: ileus, pyelonephritis investigate; TAC is requested thoraco abdominal and pelvic contrastadada reference to the third level. Treatment: Dexamethasone 8 mg IV c / 8h, Omeprazole 40 mg IV QD, Tramadol 200 mg IV in 24 h, Ondansetron 8 mg IV c/8 h. In HEEE, enter the service of Hematology diagnosed with lymphoma B cell diffuse small and medium post tumor resection and right frontoparietal Urinary Tract Infection; here is not performing Chemotherapy is achieved and reference is made to SOLCA Quito where state of the patient by two sessions of radiotherapy is done and maintained with palliative care until his death.