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Washington University Experience | METABOLIC | Wernicke Encephalopathy | 17A0 Case 17 History
Case 17 History ---- The patient was a 55-year-old female with history of smoking, hypertension, depression, and thrombocytopenia. She was admitted to an outside hospital for failure to thrive and concern for dehydration and hypovolemia. She was last seen in her normal state at 16:30 hours on 03/30. An hour later nursing saw her again and she was noted to have left sided weakness, neglect and right gaze deviation. A head CT was unremarkable. Platelets were 71K and INR 1.2. The team noted that she was aspirating so she was intubated and transferred to the ICU. CT Angiogram performed at the OSH showed a right MCA occlusion. She was transferred to the BJH ER and then taken for thrombectomy the same day. The thrombectomy was successful; however, postoperatively she developed hypothermia and severe hypotension. She was anemic with a hemoglobin of 6.2 for which she received fluids and 2 units of packed red blood cells. She required pressor support shortly after arrival. She developed right sided weakness. Head CT showed possible left-sided stroke. Her lactate was uptrending, and CT C/A/P showed hepatic, splenic, and likely mesenteric infarcts. Laboratory testing showed positivity for HIT antibody and lupus anticoagulant. She required further blood transfusions and her platelet levels continued to drop. A head CT was repeated and showed large bihemispheric infarcts. She expired in 04/06.
