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Washington University Experience | MYELIN (NON-IMMUNE MEDIATED) | Fat Embolism | 5A0 Case 5 History
Case 5 History ---- The patient was an 83-year-old woman with a history of hypertension, anemia, chronic renal insufficiency, osteoarthritis, and macular degeneration, who was diagnosed with Alzheimer’s dementia in 1998 after she became forgetful, acted strangely, and was hearing voices. She continued to deteriorate, and over the last 4-6 months was no longer able to recognize her family. She presented to BJH after having fallen down the stairs. She suffered right femoral dislocation and fractures of her left and right proximal tibia, left proximal fibula, and right clavicle. At the time of admission, she was described as alert but oriented to self only. Two days after admission, she became lethargic, would not respond to voice, and developed a right facial droop. The next morning she had an event suspicious for a seizure with bilateral upper extremity jerking and right gaze deviation. Her neurologic examination showed her to be responsive to pain only with agonal respirations, roving eye movements, weak withdrawal of the upper extremities to pain, left more than right, and rigidity of her upper extremities. Her EEG at that time showed central sharp waves and slow triphasic waves. MRI of the brain on 4/17 revealed multiple punctate regions of acute infarction in the distribution of both PCAs and the left MCA, thought to be consistent with fat embolization. She was also found to have a family history of dementia in two brothers and a sister, with onset in their 50’s and 60’s. The remainder of her hospital course was notable for episodes of hypotension and bradycardia, myocardial infarction treated with heparin, acute and chronic renal failure, worsening anemia requiring blood transfusion, hypocalcemia, hypernatremia, hypokalemia, and pneumonia. She was found apneic and pulseless on 4/27 and pronounced dead. ---- Neuroautopsy findings consisted of Alzheimer disease with congophilic angiopathy and a remote contusion in the left temporal lobe.
