ABSTRACT
CLINICAL CASE STUDIES Case 1 A 32-year-old woman, P0+0, presented to Accident and Emergency (A&E) with intractable vomiting at 9 weeks’ gestation. This was initially thought to be hyperemesis gravidarum, and she was admitted to the prenatal ward, where she was noted to have left hemi-neglect. MRI showed a large infiltrating lesion that involved the whole of the corpus callosum, extended in to the septum pellucidum and infiltrated the adjacent brain. This showed enhancement following the injection of gadolinium, consistent with a high-grade intrinsic lesion (Figs. 19.1 and 19.2). She proceeded to neurosurgical biopsy, which confirmed GBM (grade IV glioma). She deteriorated post-surgery and required admission to a local hospice, and remained there, with little further deterioration in her physical abilities, but with increasing loss of higher mental functions, until she reached 20 weeks. At that stage, ultrasound showed intrauterine growth restriction, with fetal growth below the 5th centile. She commenced a course of palliative RT aimed at delivering 30 Gy (gray) in six fractions. Unfortunately, after four fractions ultrasound confirmed intrauterine death at 22 weeks’ gestation. RT was therefore stopped, and she underwent induction of labour. The patient died 4 months later.
