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brain necrosis

Gregory Pawelski

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> During July, 1998 Ann had a 3.5 cm metastatic tumor resected from her > right cerebellum by a Dr. Ralph Lehman at Hershey Medical Center. This > brain surgeon advised us when she recovered to return to our home in > Reading, Pa. and receive brain radiation to the area of the tumor and get > an MRI because of his suspicions of either another tumor on her spine or > a herniated disc, causing her leg problems. Dr. Yuen, a radiation > oncologist at the Reading Hospital gave Ann 25 fractions of whole brain > irradiation and 5 fractions of local irradiation. Whole brain > irradiation induces neurological deterioration, dementia or both. > Patients develop progressive dementia, ataxia and urinary incontinence > after radiotherapy. Local irradiation has been applied to patients to > avoid these complications. The treatment method recommended for brain > metastases of large solitary tumors exceeding 2 cm in diameter is > surgical resection followed by 5 fractions of local irradiation. She > received an unenhanced MRI to the spine that showed a 1 cm lesion. They > then performed a Bone Scan on her that showed normal bone imaging > instead of doing an enhanced MRI to further evaluate. Enhanced(contrast) > agents increase the sensitivity, conspicuity and accuracy of an exam. > The agent most commonly used is Gadolinium. The properly prescribed > medical procedure is that contrast(Gadolinium) should always be used for > Brain and Spinal MRI's. It wasn't. Dr. Yeun told us that the lesion was > nothing and not to worry about it. Well, nine months later, she was > admitted to the Reading Hospital for a week of testing for unexplained > falls and light-headiness. Dr. Mecurio, a medical oncologist who > admitted Ann, said that Ann was supposed to be seen by an Internist (for > her blood pressure) and a Neurologist (for a spinal tap). At the end of > that week, Dr. Leaser, another medical oncologist calls me to say Ann > did not have cancer and he'll let her go home the next day. Well, she > went home the next day in time to fall and break her hip in four places. > After waiting two days to be operated on they finally repaired her hip, > by Dr. Latman, an orthropedic surgeon. After surgery Ann did not become > coherent. For two days, I tracked down the Neurologist (Dr. Reed) who > was supposed to do the spinal tap the week before and found out that he > did not do the spinal tap. I finally found him and forced him to do a > spinal tap then and there and it shows Leptomeningeal Carcinomatous(the one > lesion on the spine is now three lesions, one big enough to seep through the > meninges into the spinal fluid) Undiagnosed Leptomeningeal Carcinomatous in > patients receiving anesthesia results in Brain Death! After the > Pathologist did not want to sign off on his diagnosis, I yanked Ann out > of Reading Hospital and took her to Hershey Medical for proper medical > treatment. > > Radiation injury to the brain has a progressive (2-3 years) and insidious > course. Radiation necrosis is part of a series of clinical syndromes related > to central nervous system complications of radiation. > It generally occurs 6 months to 2 years after radiation therapy. > Radiation necrosis can be fatal! It causes pathological changes that > impair vascular integrity. It causes cerebral infarctions (strokes). Just > after the New Year, Ann suffered a lacunae infarct (small stroke) to the left > basal ganlia area. Because of the negligent overradiation she received (not to > mention the massive other malpractices), Ann's necrosis advanced to the point > of cardiopulmonary failure. Ann didn't die of cancer, she died of Radiation > Necrosis.


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