MD, 34 Y.
O, F, G9P8, 8010
History of profuse vaginal
bleeding during 5th month
pregnancy and 4 months
PTA, underwent D&C
Had recurrence of bleeding
and ceased for 2 weeks
4x4x4 Left frontal cortical
hemorrhage with
surrounding edema minimal
spillage into the third
ventricles up to the 4th
ventricle
Anisocoria, decreased
sensorium, stupurous, (+)
flexion movement of UE,
no eye opening, (+)
shoulder shrug, (+)
abdominal breathing, (+)
Corneals, (+) gag reflex
No motor response,
passage of coffee ground
material per NGT,
tachycardic, febrile
Vaginal bleeding (2x D and C)
TransVaginal UTZ
High vascular heterogenous mass
CHORIOCARCINOMA within post myometrium
Theca lutein cyst, left
Multiple uniocular cyst, left ovary
Hematogenous Route
Brain Lungs Cough
Implantation of syncitiotrophoblast
and cytotrophoblast
Disruption of Blood Brain Barrier
Elevated WBC
Decreased RBC
Decreased Hgb, Hct
Disruption of Blood Vessels Elevated Neutro
Decreased Lympho
Decreased Eosinophils
Subarachnoid hemorrhage
Left Temporoparietal hematoma
Right sided hemiparesis,
aphasia, projectile
vomiting, shallow naso-
Uncal Herniation Increase Blood volume
labial folds, right; weak
and ICP; Tissue Ischemia gag reflex, weak shoulder
shrug, right; tongue
Brainstem deviation to the right)
Compression
Headache
Vomiting
Motor and Sensory
Comatose Disturbance (preferential
gaze to the left, weak gag
reflex)
Cardiopulmonary
arrest
DEATH