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Washington University Experience | MYELIN (IMMUNE-MEDIATED) | AHL | AHL | 7A0 Case 6 History
Case 7 History ---- This 34-year-old female developed left eye pain and was diagnosed as having optic neuritis 3 weeks prior to admission. A lumbar puncture was performed and revealed 40 RBCs; 11,730 WBCs w i t h 86 percent polys; total protein, 131; glucose, 37. She was given Ceftriaxane. CAT & MRI scans of the head showed a lesion in the right medial frontal cortex with thickening of the anterior corpus callosum. Cultures of her cerebrospinal fluid were negative. She was discharged three days later. Within the next few days the patient became very confused, had brisk reflexes, left ankle clonus and bilateral Babinski's; and was subsequently admitted to another hospital, She was treated with Decadron and Acyclovir. A repeat CAT scan showed increase in the bifrontal lesions and an emergent left frontal white matter biopsy, by drill needle was performed. The biopsy showed sheets of histiocytes, but no polymorphs or viral inclusions. The patient progressively deteriorated. She was given Mannitol, but remained unresponsive. Blood pressure was 101/55 with a fever of 102.9oF. Pertinent laboratory data included a white blood cell count of 12,100 (77% polys, 16% segs, 7% monos). Her EEG was flat line and the patient was deemed brain dead. The family agreed to withdraw supportive measures. The patient was pronounced dead at 7:50 p.m. on the day of admission. Necropsy Findings: The brain was markedly but symmetrically edematous with evidence of transtentorial and foramen magnum herniation. On coronal sections there were several large greyish plaques in the white matter at several levels which spared the cortex. Secondary brain stem hemorrhages were present.
