Table of Contents
Washington University Experience | METABOLIC | Wernicke Encephalopathy | 3A0 Case 3 History
Case 3 History ---- This 48 year old man had a long term history of chronic alcoholism, nutritional depletion, Hepatitis C and smoking. His final hospital visit involved excessive weight loss, emesis, cough and chills. Initial labs were notable for an elevated white blood cell count, hyponatremia, and decreased albumin and protein. CXR was thought compatible with aspiration pneumonia and he received broad spectrum antibiotics. He had a sudden change in mental status which promoted a non-contrast head CT examination which showed early volume cerebral loss/atrophy. He fell in the shower striking his head. A head CT at that time showed acute subarachnoid blood mostly involving the left sylvian fissure with smaller collections of blood frontally, in the temporal area and along the falx. During preparation to transfer him to the ICU, intubation was performed and he was noted to have lost brainstem reflexes. Soon thereafter he had an observed cardiorespiratory arrest. A repeat head CT showed more substantive subarachnoid, subdural, intraparenchymal and intraventricular hemorrhage. A hematoma within the left temporal lobe exerted mass-effect upon the left lateral ventricle with approximately 7 mm left-to-right midline shift. He expired shortly thereafter.
