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Diagnosed with early stage ovarian cancer and brain tumour. On antibiotic. Looking for proper diagnosis

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Neurologist, Surgical
Practicing since : 2002
Answered : 173 Questions
The reason I am on this website is because I am very concerned about a family member who is hospitalized declining quickly while doctors have no clue as to a diagnosis.
Here is the situation:
My 82 year old grandmother was hospitalized about a month ago because she felt sick. Doctors found that her abdomen was full of fluid and proceeded to drain it. After a week of tests, doctors diagnosed her with early stage ovarian cancer and decided to start her on a few chemo treatments. However, they had much trouble finding a tumor. Her white count was normal in addition. Something that they described as very small showed up after several CT scans and MRI's, but I don't believe they were sure it was a tumor. Nevertheless, they sent her home and they said she had good chances of recovery because they caught it so early.

When she returned home, she felt weak and fell. After the fall, she very quickly declined and now I believe her life is in danger. She started slurring her speech and becoming very confused. She was taken back to the hospital where she has spent the last week with delirium. Now she has lost the ability to speak and sleeps a lot. When I visited her tonight I was stunned. It seems as though she has mental retardation (I know you can't suddenly develop this but this is what the symptoms remind me of). She could not make eye contact, her eyes are VERY bloodshot and also very crossed. Also, the back of her hand is literally completely bruised, it's all black, I have never seen anything like it. She is slumped in her chair and cannot control her movement. She can mumble "Uh-huh" when I talk to her and acknowledges I'm there and can squeeze my hand. But that is all.

Doctors have ruled out a brain tumor or stroke with 2 MRIs and a CT. Also they say she does not have Alzheimer's or dimentia because they wouldn't have come on so quickly. They think she had a UTI and decided to start her on antibiotics, thinking the infection caused the delirium. She did not respond and has gotten much worse. Her doctors now have no idea as to a diagnosis and don't want to transfer her to a different hospital because she is too unstable.

To any doctor who reads this: Can you think of some diagnosis they are missing? Do you think there is actually early cancer or was that a misdiagnosis hiding something much more dangerous? Something is very wrong, do you have any suggestions? Anything that I can bring up with her doctors to give them something to work off? This is very confusing as it happened so quickly. I would appreciate any advice.
Thank you.
Posted Fri, 16 Nov 2012 in Cancer
Answered by Dr. Vineet Saggar 9 hours later

Thanks for the query.

I am sorry to hear about your grandmother. I wish her good luck...

To answer your query, I believe doctors don't have any reason to hide anything from you; so have faith.

A few options that can be considered by the doctors are:
1. To look at her serum electrolytes. I am pretty much sure, the doctor's would have got this checked and corrected any disturbances.
2. I also suggest contrast enhanced MRI brain to rule out carcinomatous meningitis
3. A lumbar puncture and Cerebrospinal analysis is also recommended.
4. We also need to look at her serum ammonia levels to rule out hepatic encephalopathy as this can be associated with ascites (fluid in the abdomen) and metastatic disease.

I hope you found something useful. Please discuss with her treating doctor. I will be available if you have further concerns.

Above answer was peer-reviewed by
Follow-up: Diagnosed with early stage ovarian cancer and brain tumour. On antibiotic. Looking for proper diagnosis 33 hours later
Hello Dr. Saggar,

Thank you for your suggestions. Today I found out that a contrast enhanced MRI was performed as well as an MRA, which both were negative for everything. I also learned the doctors performed a test for Myasthenia gravis, which was also negative. Her condition hasn't changed much, except that the one side of her face is drooping badly, as if she had a stroke, but don't you think a stroke would appear on the CT, any of the MRIs, or the MRA?

Also, one more thing I learned which may be rather important, when she was taken to the hospital last week with the severe confusion, doctors found two blood clots in her lungs (possibly from her earlier hospital stay) and immediately gave her blood thinner to break up the clots, which to my understanding was successful in there are no clots in her lungs now. Do you think this could possibly have anything to do with it? Her doctors are meeting today to discuss possibly transferring her to a different hopsital in a bigger city, because they believe they have ruled out any disease that commonly presents with these symptoms. I think they believe, as do I, that this is something rare.

If you have any more theories would you please let me know?
Once again, I really appreciate your help, so thank you!
Answered by Dr. Vineet Saggar 17 minutes later
Dear Friend,

I do agree that stroke would be seen on MRI, but you did not mention any thing about Serum Ammonia levels to rule out hepatic encephalopathy. Since you mentioned about pulmonary clots she may also suffered hypoxic damage to brain. Is she on ventilator ? I would like to know these.

Above answer was peer-reviewed by
Follow-up: Diagnosed with early stage ovarian cancer and brain tumour. On antibiotic. Looking for proper diagnosis 58 minutes later
I didn't find out anything about serum ammonia levels. Also, she is not on a ventilator but I feel as if she will be soon because she is losing all functions as time passes here. You mentioned hypoxic brain damage. Is it possible for the symptoms to gradually get worse over the period of about two weeks? She was given blood thinner as soon as she was admitted, so is that normal for brain damage to keep getting progressively worse even after the clots are treated?

Answered by Dr. Vineet Saggar 16 hours later
Thanks for writing back.
Yes, it is possible for these functions to deteriorate over time once it starts but that is secondary. You should get lumbar puncture and contrast MRI brain to rule out carcinomatous meningitis and serum ammonia levels done.
Above answer was peer-reviewed by
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