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P OSTER
A BSTRACTS
paralysis is seen for 36-48 hours then medical therapy is fully acceptable.
In conclusion, the clinical presentation of epidural abscesses is
often non-specific and should be investigated in atypical scenarios.
C17
Case Report: A primary mucinous adenocarcinoma with multiple
recurrences and a 24 year survival.
C. M. Espinal, 1,2 N. K. Patel, 1,2 R. W. Parker. 1,2 1. Geriatrics, University
of Texas Health Science Center at SA, San Antonio, TX; 2. Geriatrics,
Christus Santa Rosa, San Antonio, TX.
INTRODUCTION: Advanced stage mucinous carcinoma of the
ovary is very rare and is associated with poor overall survival. We report
a case of a patient who has survived 24 years since her diagnosis
of mucinous adenocarcinoma.
CASE REPORT: A 70 year old (y/o) hispanic female with a 24
year history of ovarian mucinous adenocarcinoma diagnosed at 46
y/o in Mexico(1987). She underwent exploratory laparotomy due to
recurrent abdominal discomfort, was diagnosed with mucinous adenocarcinoma
of the left ovary. The patient was managed with
oophorectomy and chemotherapy. Latter in the course of her disease
she had about six laparotomies for removal of recurrent abdominal
mucinous collections. The last recurrence was at the left pleural cavity.
She has three fistulas on her left upper back draining serous fluid
since 2009. The patient presented to our clinic with a desire for surgical
evaluation for possible closure of fistulas, to regain her quality of
life. She is limited in her socialization because of the fistulas and
drainage. A CT of the chest demonstrated prior surgeries as well as
lesions that extend beyond the pleura into the overlying chest wall.
She was referred to a surgeon experienced with the geriatric population
for management of the fistulas and also to an oncologist.
DISCUSSION: Primary mucinous tumors are classified into benign,
borderline, or malignant categories depending on their
histopathology characteristics. For women with regional and distant
disease, 5 year survival rates are 73% and 28%, respectively. These tumors
usually develop in the third to fifth decades of life and typically
cause vague symptoms, such as increasing abdominal girth, abdomino-pelvic
pain, fatigue, constipation, and urinary incontinence.
The patient started experiencing abdominal symptoms in her late
40’s. Fortunately she had appropriate management with frequent interventions
of her abdominal recurrence and pain management. Her
wishes have always been to be able to live and enjoy her family.
CONCLUSION: The survival rates for women with ovarian
cancer and distant-recurrent disease is low, but considering the benefits
versus the risk of cancer management, one should consider not
only the comorbidities and life expectancy but quality of life. The patient
and the family’s preferences should be an important part of the
decision making for the plan of care.
C18
Thirteen courses of ECT over 4 years in an Alzheimer’s patient. Is it
helping?
C. D. Teodoro, M. Leiding, M. Gorbien, J. Olson, M. Bednarczyk.
Section of Geriatric Medicine and Palliative Care, Rush University
Medical Center, Chicago, IL.
Purpose:
To highlight the need for evidence-based practice guidelines in
the use of ECT in persons with dementia and depression.
Background:
Electroconvulsive therapy (ECT) is a widely accepted treatment
for older adults with medication refractory depression. Although
evidence is limited, ECT is presumed to be effective in treating
depression in older adults with dementia. Because patients with
advanced dementia are difficult to interview, surrogate markers for
depression must be used, such as function, oral intake, agitation or aggression.
We present an extreme case of a woman with Alzheimer’s
dementia, who has required repeated admissions for ECT to treat
symptoms presumed to represent depression.
Method: Case report
Case Report:
Mrs. G. is an 81 year-old female with Alzheimer’s dementia, who
has been admitted to the gero-psychiatry unit thirteen times since
Aug 2007 with symptoms of severe anxiety, insomnia and anorexia.
Despite multiple pharmacologic therapies and use of outpatient
maintenance ECT, her depression continues to relapse. She received
a mean of 9 treatments per admission, a minimum of 7 and maximum
of 15. Along with improved sleep and oral intake, one of the clearest
indications ECT is helping Mrs. G. has been the condition of her knitting.
A life-long knitter, she is always admitted with balls of yarn, her
needles, and a hopelessly, tangled, knitted scarf. By discharge, her new
scarf has few to no errors.
Discussion:
In the case of Mrs. G., ECT appears to relieve her depression, albeit
temporarily. However, due to her dementia, ECT’s effect on cognition
cannot be fully evaluated. In addition, observation of surrogate
makers for depression by caregivers is subjective and difficult to standardize.
A review of the literature reveals retrospective chart reviews
and case reports describing ECT efficacy and purport its safe use in
the treatment of depression with co-morbid dementia. However,
these are limited in number, and descriptive in nature. While we acknowledge
ECT’s therapeutic benefit in depressed patients, its use in
those with underlying dementia still necessitates careful consideration
and selection of the patients to be treated.
C19
Alzheimer’s Disease versus Hippocampal Sclerosis (HS): Is There a
Clinical Imperative to Diagnose HS?
D. M. Otero, K. Sharma. Division of Geriatrics, Albert Einstein
College of Medicine, Montefiore Medical Center, Bronx, NY.
Hippocampal sclerosis (HS) is a pathologic term used to describe
severe loss of neurons and reactive gliosis in the hippocampus.
HS is associated with hippocampal atrophy, severe amnesia, and
slowly progressive dementia without clinical seizure activity. HS is
found bilaterally in 50% of cases and 25% on the right or left side
only. HS is difficult to distinguish clinically from Alzheimer’s disease
(AD) and is often diagnosed postmortem. In autopsy series, HS is described
in 1-5% of cases as an isolated diagnosis. However, HS has
been described in up to 26% of cases when it occurs in combination
with other vascular and neurodegenerative disorders.
Case: A 78 year old woman was evaluated because the family
had noticed changes in her behavior for 6 months. She had no significant
PMH or toxic habits. The patient, a retired book-keeper with a
high-school education, was no longer paying her bills, her house was
disorganized and dirty and she could no longer use the computer.
General PE: Unremarkable. Neurological: No focal signs. Psychiatric:
No signs or symptoms of depression or personality change. Mental
Status Testing: Clock Drawing Test: 3 (3 or > cognitive deficit); Mini-
Mental State Examination: 21/30. Laboratory data revealed normal:
chemistry, CBC, TSH, B12 and folate levels. Given the atypical presentation
and rapid deterioration, the patient was referred for neuropsychological
(NP) testing. NP testing revealed preserved insight.
Memory was markedly impaired for both verbal and nonverbal material.
However, she displayed a high level of nonverbal reasoning
which was unexpected given her marked memory impairment. Verbal
intelligence was near superior. The patient’s profound memory impairment
in the context of well-preserved reasoning ability is an unusual
profile for AD and HS was considered. MRI showed nonspecific
vascular changes which is often seen in HS.
Discussion: HS is distinguished from AD by the findings of preserved
reasoning in the setting of profound memory loss early in the
disease. HS is currently a pathological diagnosis however new research
suggests that HS can be diagnosed with NS testing.This case il-
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AGS 2012 ANNUAL MEETING