A 25 year
old woman presented with increasing ataxia and lethargy.
Five years ago she was diagnosed with a melanoma Clark level
II of the right cheek. Neck dissection was performed 3.5
years ago for recurrence in a submandibular node. A few
months following surgery, she developed severe nausea,
vomiting, and headache. A head CT and MRI showed left
parietal and right frontal metastatic lesions, for which she
underwent surgery, but refused to receive any postsurgical
external beam radiation treatment.
One year ago, after
the patient had a seizure, MRI showed ventricular metastatic
lesions for which she underwent radiosurgery. Later, a
ventriculoperitoneal shunt was placed to relieve the
hydrocephalus that had developed.
Six months ago she had
several grand mal seizures, and MRI showed right cerebellar
metastatis for which she was once again treated with
radiosurgery. Serial MRIs performed thereafter showed no
change. A recent MRI, however, showed increasing ventricular
size and multiple metastases to the brain.
