PMC9044027_01
Before and after; MRI scans, pictures of scores, and DSAs. MRI (magnetic resonance imaging) scans before and after tumor resection, clinical pictures of sores on right foot and left hand at admission and at end of hospitalization, and DSA (Digital Subtraction Angiography) images before and after embolization.
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Upon alpha blockade and blood pressure stabilization the patient gained weight (Figure 1), and the chronic sores and necrotic fingertips and toes started to heal (Figure 2). ADL (activities of daily living) functions were assessed and trained intensively. After approximately 2 months of alpha-blockade treatment the patient was able to swallow bread crusts, not just liquids and soft foods (see Figure 1).
Development of the patient's weight (kg), normetanephrine levels, antihypertensive medicine, nutritional intake, and physical location over the first 365 days of hospitalization. Black lines: embolization procedures, orange line: tumor resection surgery, orange rhombes: plasma-3-methoxy-norepinephrine levels (nmol/L), blue arrows: changes in blood pressure medications, green blocks: changes in the patient's ability to drink/eat. She was at no point able to sustain nutrient intake without supplemental nutrition by naso-gastric tube. Black boxes show the patient's location.
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The patient had multiple chronic ulcers on her feet and lower legs, including decubitus on both heels and lower back (Figure 2). Due to the central facial nerve palsy diagnosed on day 31 repeat CT scanning as well as magnetic resonance (MR) imaging were performed, revealing a giant (93.553cm3) tumor of the skull base located both intra- and extracranially (Figure 2). Upon alpha blockade and blood pressure stabilization the patient gained weight (Figure 1), and the chronic sores and necrotic fingertips and toes started to heal (Figure 2).