CASE HISTORY

In January 1953, patient commenced to have headache, vomiting and diplopia. In March 1953, he was admitted and a tumour of the vermis was removed. He was then transferred for a course of radiotherapy. A year later symptoms recurred and in November 1954. he was readmitted with severe headaches and vomiting. Further exploration of the posterior fossa was conducted and a large extra-dural cyst was removed but no tumour was found. Following this he became double incontinent and his gait deteriorated and he developed flexor spasms in the left leg. He was finally readmitted at the end of January when he had tenderness over the decompression space, bilateral optic atrophy , left ptosis, unequal pupils, nystagmus and frequent flexor spasms in the left leg. There was sensory impairment of L3-S4 more marked on the right. C.S.F. pressure 300mm, H20. Protein 2,400mgm% Xanthochromia. A large transection of the spinal cord at D12 was suspected and radiotherapy was considered but it was agreed that further treatment was futile and he went steadily down hill and died.

PATHOLOGY

At postmortem there were some deposits of tumour at the base of the brain over the temporal lobe and around theolfactory nerves but there was no apparent recurrence in the region of the cerebellum. The specimen comprises several sections of spinal cord and cauda equina. Surrounding the spinal cord, as seen in the three right-hand specimens, there is a solid greyish-white mass of tumour which completely encases the cord at all three levels and surrounds its nerve roots. In the cauda equina there are innumerable rounded deposits of tumour on the various nerves invading them and causing a bead-like swelling. There is also an invasion of the arachnoid giving it a milky appearance in patches.