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Extracranial Metastases from a Cerebellar Medulloblastoma

Corticosteroids have been used either alone or in combination with other treatments in 18 of the survivors (Amorosi & Ultmann 1966). However, their use in TTP is almost universal, and assessment of their contribution is accordingly difficult. Heparin has been widely advocated on the basis that it may inhibit fibrin deposition, thus preventing vascular occlusion and limiting renal damage and haemolysis. Two survivors have received heparin and high dose corticosteroids (Bernstock & Hirson 1960, Richardson & Smith 1968). In the present case, improvement in platelet count and plasma hemoglobin coincided with treatment with heparin and blood transfusion. Hydrocortisone given for 12 hours had failed to prevent the progression of hxemolysis and thrombocytopenia. Renal failure is a common complication of TTP, and this case is notable for the degree of recovery which occurred. The patient was not known to have been hypotensive at any time, but the pattern of recovery suggested a significant degree of tubular damage. Persistence of retrograde amnesia is an unusual feature of this case and suggests a localized lesion, possibly of the mammillary bodies. Perhaps the most important lesson in this case is that it demonstrates that in TTP recovery may occur in spite of an apparently hopeless combination of cerebral and renal disease.